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Heart Failure

What is heart failure? Heart failure is a condition where the heart cannot pump enough blood to meet the body's needs. Heart failure can get worse with time, has a severe impact on quality of life and is associated with a significantly reduced life expectancy. The main symptoms of heart failure are:

  • General fatigue or weakness
  • Shortness of breath
  • Swelling in the legs and ankles

Why does heart failure happen? The heart is a muscle that pumps oxygen-rich blood to the body in two phases. In the first phase, the heart relaxes and fills with blood. In the second phase, it contracts and pumps blood out. Heart failure occurs when the heart does not fill properly and/or does not pump out enough blood to meet the body's needs. People with heart failure may have a thick and stiff heart that cannot fill properly, and/or may have a weakened heart that cannot pump out enough blood.

Are there different kinds of heart failure? One condition that may lead to heart failure is high blood pressure, which makes the heart work harder to pump blood out to the body. Like any muscle, the heart responds to this higher workload by becoming thicker and stiffer, preventing it from filling properly. This is called diastolic heart failure.

Just as a car tire requires higher pressures to inflate than a balloon, a thick, stiff heart requires high pressures to fill. In order to fill a thick and stiff heart, blood pressure in the lungs rises, causing fluid to seep out from vessels into the air spaces in the lungs. This condition, called pulmonary edema, can cause serious breathing problems. High blood pressure in the lungs and heart also causes blood to pool in the legs which leads to swelling.

Other conditions, such as a heart attack, deprive the heart of oxygen, damaging and weakening muscle tissue. As a consequence, heart walls can no longer squeeze strongly enough to pump out sufficient blood to meet the body's needs. This is called systolic heart failure.

What treatments are available for diastolic heart failure? There are no proven treatments available today for people with diastolic heart failure. Medications may alleviate symptoms, but do not change the course of the disease or improve survival.

Why is it important to treat heart failure? Heart failure affects 5.7 million people in the United States1 Diastolic heart failure, or heart failure caused by heart filling problems, occurs in about half of all heart failure patients.2 Studies have shown heart failure patients who do not receive effective treatments to improve heart function have a poor quality of life and a high risk of death. The mortality rate for these individuals is high with 74 percent dying within five years.3

Heart failure is also an expensive disease. In the United States, the direct and indirect costs associated with heart failure are estimated to be $37.9 billion for 2009.4

Sources:

(1) Lloyd-Jones DM, Larson MG, Leip EP, et al. for the Framingham Heart Study. Circulation. 2002;106:3068-3072.

(2) Owan TE, Hodge DO, Herges RM, et al. N Engl J Med 2006;355:251-259.

(3) Lee DS, Gona P, Varson RS, et al. Circulation 2009;119:3070-3077.

(4) Centers for Medicare & Medicaid Services. Health Care Financing Review: Medicare & Medicaid Statistical Supplement. Table 5.5: Discharges, Total Days of Care, and Program Payments for Medicare Beneficiaries Discharged from Short-Stay Hospitals, by Principal Diagnoses Within Major Diagnostic Classifications (MDCs): Calendar Year 2006. Baltimore, MD: Centers for Medicare and Medicaid Services; 2005. Available at: http://www.cms.hhs.gov/MedicareMedicaid StatSupp/