Living with Congestive Heart Failure

Advances in treatment mean patients can live longer and healthier lives, even with reduced heart functioning.

Heart failure, also known as congestive heart failure, is a condition where your heart can no longer pump enough blood for your body. It can be caused by a heart attack, heart disease, or an infection—and it often occurs along with other life-threatening complications.

"Many patients hear 'heart failure' and immediately think 'heart transplant' or 'death,'" Sara Tabtabai, MD, co-director of the University of Connecticut Heart Failure Center, told Health. However, many people live for years with heart failure. "I try to reassure them that for most patients there are many options before we get anywhere near that: our focus is to decrease or eliminate symptoms and improve heart function as best we can."

What is Heart Failure?

Heart failure doesn't mean the heart stops pumping entirely, according to Dr. Tabtabai. Rather, there are two types of heart failure: one in which the heart muscle's pumping ability is reduced (to less than 40% efficiency, down from 45% to 65% in healthy individuals), and one in which the heart pumps normally but is unable to relax and fill with blood between contractions.

Both types of heart failure cause similar symptoms. "People can feel really fatigued, or experience a decrease in their ability to exercise or do daily activities," Dr. Tabtabai said. "Shortness of breath is very common, and so is swelling of the legs or ankles." When swelling occurs—due to blood not circulating properly and fluid accumulating in the lower extremities—the condition can be called congestive heart failure.

Treatments

There is no cure for heart failure, and it will quickly get worse if left untreated. But the good news, according to Dr. Tabtabai, is that medications and lifestyle changes can help keep the condition under control. That is especially true for the type of heart failure that involves a reduced pumping ability.

"We have very clear medication guidelines we can put patients on—and often with these medications, we'll see the pumping function can improve over time," Dr. Tabtabai said. "It's important for patients with this type of heart failure to get on the right kind of medication and take it as prescribed, and it's very likely they see an improvement in how they feel and how much activity they're able to complete."

Some medication for heart failure has been shown to increase lifespan and reduce hospital stays. "It's difficult to predict how patients will do, and it's not really based on the percentage their pumping function is reduced," Dr. Tabtabai said. "Some people have very low pumping function but they feel well, have minimal symptoms, and go on and live for a long time."

For the other type of heart failure—in which the heart muscle becomes stiff and is unable to relax—treatment is trickier. "We do not have targeted medications for this type," Dr. Tabtabai said, "but we can focus on improving symptoms of shortness of breath and cardiac risk factors such as high blood pressure."

In advanced cases of heart failure, patients are sometimes treated with surgical procedures, including heart transplants or the implantation of a defibrillator or an artificial pump called a left ventricular assist device (LVAD). These options can be stressful for both patients and their caregivers, but they can also provide significant improvements in quality of life.

Lifestyle Choices

Diet and lifestyle choices are important to reducing your risk for heart failure. For example, a low-salt diet can also help heart failure patients prevent complications and retain a good quality of life, Dr. Tabtabai said. Some patients are also put on a fluid-restriction diet (in which they only drink 2 liters of liquids a day) or prescribed diuretic medications to reduce swelling.

Working out can be challenging for patients with heart failure, but following an exercise routine can help people feel better and improve their ability to do other types of physical activity, Dr. Tabtabai said. A 2018 ESC Heart Failure review supports that: exercise not only reduced the risk of developing heart failure but also reduced the chances of hospitalization or death for people with heart failure. Talk to your healthcare provider about gradually increasing your exercise routine at a pace that's safe and manageable.

According to Dr. Tabtabai, regular exercise and following a healthy diet early in life can help prevent heart disease—and related heart failure—later in life. It can also help people who do develop heart failure live longer and healthier. Managing blood pressure is also important, Dr. Tabtabai added.

"In my practice, I try to identify people who are at risk of developing heart failure and heart disease and try to highlight that these sorts of lifestyle measures are really very beneficial," Dr. Tabtabai said. "If they can get in a good routine early in life, that's our best defense against developing these conditions down the line."

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