Heart failure is a silent epidemic in Poland. The cardiologist tells you what the symptoms are

Proven content

Thanks to invasive treatment, cardiology copes better with heart attacks, which paradoxically increases the percentage of chronic heart diseases, such as heart failure. Recent estimates say that in Poland as many as 1 suffer from heart failure. people. Unfortunately, we also occupy the infamous first place among 300 highly developed countries in terms of the number of patients hospitalized due to this disease. Do we have a chance to improve the situation of patients? We talk to prof. dr hab. med. Ewa Straburzyńska-Migaj.

1. The number of cases of heart failure is increasing. Among all OECD countries, there is the highest number of hospitalizations for this reason in Poland
2. Hypertension, ischemic heart disease or inflammation of the heart muscle can cause heart failure. But not only that – it also affects patients with diabetes or thyroid diseases
3. Prof. Ewa Straburzyńska-Migaj tells what are the most common symptoms of heart failure and what should pay special attention
4. In an interview with Medonet, the expert also explains what are the treatment options and what can be done to improve the situation of patients with heart failure in Poland.
5. You can find more such stories on the TvoiLokony home page

Monika Zieleniewska, MedTvoiLokony: Most Poles associate heart disease mainly with heart attacks, which are the aftermath of ischemic heart disease. Meanwhile, less popularized heart failure is the second most common cause of death in cardiovascular disease.

Prof. Ewa Straburzyńska-Migaj: Indeed, there is already considerable public awareness of myocardial infarction and ischemic (coronary) disease. People associate that in the event of a heart attack, the timing of treatment is decisive, they also know the nature of this ailment, associated with chest pain. On the other hand, awareness of other heart diseases is much less.

We, the doctors associated with the Association of Heart Failure of the Polish Cardiac Society, try very hard to ensure that knowledge about it also grows. Because the problem is getting worse, paradoxically, among others Due to more and more effective treatment of ischemic disease and heart attacks, the risk of heart failure increases and the number of patients increases.

What is the relationship between coronary artery disease and heart failure?

Several decades ago, we were not yet able to effectively treat myocardial infarction, many patients died early or later due to complications. Now, with invasive treatment at our disposal, we have significantly reduced both early and late mortality. More and more people are going through the acute phase of a heart attack, but coronary artery disease is a chronic disease and many people go on despite treatment. As a result, further changes in the coronary vessels and ischemia of the heart muscle appear periodically, the so-called mute, that is, asymptomatic.

Unfortunately, repeated episodes of ischemia and the risk of myocardial infarction lead to damage to the heart muscle and, years later, to the development of heart failure. Coronary heart disease is the most common cause of heart failure, but it can occur in the course of any heart disease, including hypertension, heart defects, arrhythmias, inflammation of the heart muscle.

Do only cardiovascular diseases lead to heart failure?

Not only that, for example, diabetes can damage the vessels. Diabetic patients are at high risk of developing heart failure. They don’t really die of diabetes, but of cardiovascular complications – coronary heart disease, heart attack or heart failure. Thyroid disease can also cause heart failure.

The number of patients is growing rapidly and this is reflected in the statistical data …

It is estimated that in Poland there are approximately 1 patients with heart failure. people. Although there are fewer of them than, for example, patients with atrial fibrillation or coronary artery disease, heart failure is a clinical condition with poor prognosis. It worsens the quality of life, and patients are often hospitalized. Heart failure is the most common cause of hospitalization in people over 300 years of age. Unfortunately, for several years Poland has been ranked first (among 65 OECD countries) in terms of the number of patients hospitalized for heart failure.

Is it only about people over 65?

No, about the total number of people hospitalized with heart failure per 100 residents.

How did we earn this investment?

The causes are complex; On the one hand, as I mentioned, it is a disease with poor prognosis, but better and better treated. In recent years, several new drugs have appeared, and besides, we can treat patients more and more effectively.

A significant problem is the lack of organized care for patients with heart failure. After hospitalization due to exacerbation of the disease, the patient is most often discharged from the hospital with the general recommendation: further care in the GP and cardiology clinic. It is often not specified how this care is to be carried out. Meanwhile, we know from numerous publications that a patient after hospitalization gains a lot if the first visit takes place 7 – 14 days after discharge. It may even be a teleportation visit, even led by a GP or a properly trained nurse. The patient should have visits planned in such a way that after a month he can visit the GP surgery or cardiologist, and every three months during the year for control visits at the cardiology clinic. Depending on its condition, diagnostic tests or treatments should be performed, because the treatment of heart failure is, on the one hand, pharmacotherapy, which is the basis, especially in heart failure with a reduced ejection fraction.

1. You can order an online consultation with a cardiologist at haloDoctor.pl

Let’s explain what it is about when we are talking about a lowered ejection fraction.

Heart failure is a condition in which the heart does not pump enough blood to meet the body’s needs under conditions of rest and exercise.

We have two types of heart failure – failure with a reduced ejection fraction and a preserved ejection fraction. In the first case, the heart cannot contract enough to push the appropriate volume of blood onto the circuit. The systolic function is most often presented in the form of the left ventricular ejection fraction. The ejection fraction is the amount of blood the heart throws out during systole, expressed as a percentage of the heart’s volume during diastole. Thus, during diastole, a certain amount of blood flows to the heart, e.g. 100 ml, and 70% of that in a healthy heart. that is, 70 ml is ejected on the periphery. In a heart with damaged systolic function and a reduced fraction, it will be, for example, 30 percent.

And the second type of heart failure?

Preserved ejection fraction remains above 50%, and the problem is that the heart is stiff, thick and does not relax. Its volume does not increase during diastole. Then, for example, instead of 100 ml of blood, the ventricle only accepts 70. Therefore, less blood is thrown onto the circuit during contraction. In this case, our treatment is less effective.

Until recently, we did not have good news for patients, because none of the therapies used in heart failure with a reduced fraction prolonged the life of patients with the conserved fraction. However, at the congress of the European Society of Cardiology, the results of the study of phosin, a new drug for heart failure that had previously been very useful in treating patients with reduced ejection fraction, were announced to be effective in patients with preserved ejection fraction.

The drug is new, so it may not be reimbursed?

No, we do not reimburse new drugs, which we particularly regret. There will be a few similar drugs with proven effects, but unfortunately none of them are reimbursed.

I understand that the reimbursement chance is slim and the drugs are expensive?

I’m afraid so. And patients, in order to benefit from it, should take several medications, just non-reimbursable ones. We educate our fellow doctors about new treatment options, we also educate patients, we encourage them to join associations that, on the one hand, are to help establish contacts and provide support, and on the other hand, to promote reliable information about the disease. Additionally, they can be a voice supporting us, doctors, applying to decision makers for reimbursement. Cancer patient organizations are now most effective and they are a model for associations of cardiac patients. We want to reach the awareness of patients, so that they can take care of themselves, so that they do not wait for a doctor, and imagine that the prognosis of heart failure is worse than in some neoplastic diseases, such as prostate or breast cancer.

Does the incidence of heart failure increase with age?

It is indeed an age related problem. Heart failure occurs relatively rarely in younger age groups, but increases after the age of 65. Over 10 percent the population over the age of 65 has heart failure.

What symptoms should draw our attention to?

Firstly, decreasing exercise tolerance. In other words, when we feel tired we don’t have a problem until recently, it is difficult for us to catch our breath.

In addition, shortness of breath during exercise and swelling around the ankles, symmetrically on both limbs. Swellings usually appear during the day and increase until the evening, but decrease or disappear significantly after the night. As the disease progresses, the swelling covers an increasing part of the lower limbs and does not disappear after a night’s rest. On the other hand, dyspnea occurs with less and less effort, and in very advanced states even at rest. A patient who waits for the disease to resolve itself eventually sleeps upright… and after the third consecutive night, when unable to lie down, most often reports to the doctor. This is especially true of young people in their thirties who think they may have a cold. Besides, they are sometimes treated by family doctors as people with an infection and treated with an antibiotic.

As for the elderly, attention must be paid to these symptoms in those who suffer from another cardiovascular disease – hypertension, coronary artery disease, heart defect, and in patients after PTCA or PCI of the coronary arteries. I want to emphasize that a person who is theoretically healthy, but also with diabetes, should not ignore similar symptoms.

1. Prophylactic heart examinations should be performed at least once a year. Don’t wait. Order the package of diagnostic tests “Heart control”

How can patients treated for heart failure ensure the comfort of their lives?

First of all, they must remember that drugs should be taken systematically, do not take breaks, and if they would like to change something in the treatment, they must consult a doctor. Pharmacotherapy significantly improves the patient’s well-being, and he thinks that he no longer needs to take medications. This is a trap that you must not get caught in. According to the new guidelines, the patient should take five drugs as the basis of treatment, plus additional ones, added in case of increased heart rate, atrial fibrillation or diabetes, so it makes a whole bunch of it. The sick person must be aware that in order to stay in good shape, they must take all of them. Full treatment offers a chance of significant improvement, sometimes normalizing the abnormal heart function, but to keep it in good shape, it is not interrupted.

And in addition to drug treatment?

The so-called non-pharmacological treatment, i.e. education of patients and their relatives, physical activity, vaccinations against influenza, pneumococci, and now also against coronavirus. If a patient develops pneumonia, flu, COVID-19, our treatment may not be effective, the patient may become unstable and may even die. In addition, a proper diet, fight against stimulants.

Cardiac rehabilitation would also be very useful. On the one hand, it consists of an assessment of what kind of load will be safe for the patient and the implementation of appropriate training. On the other hand, the assessment of risk factors for the worsening of the disease course, the use of appropriate pharmacological treatment, its modification and determination of indications for other methods of treatment.

Other treatments are, for example, implantation of an electrotherapy device such as a cardioverter and defibrillator or resynchronization simulator. Any patient with a reduced ejection fraction who has been unsuccessful with pharmacological treatment for at least three months should have a cardioverter defibrillator implanted, unless he has another disease that will shorten his life to less than a year. A cardioverter implantation does not directly treat heart failure, but it prevents sudden cardiac death. Meanwhile, the CPR heals, improving heart function and extending life. Each patient should be evaluated for a candidate for treatment with revascularization, i.e. for coronary artery disease that can be specifically treated, or for a heart defect that can be treated with surgery.

If your heart failure is advanced and treatments are no longer available, you can still have a left ventricular assist device or a heart transplant.

1. The editorial board recommends: These symptoms predict a heart attack many months in advance

What are the chances that the health care system will take care of the patient in such a comprehensive way?

This is a difficult problem. Experts in the section of heart failure have long said that we should have special organized care for people with this disease. We have even developed a program called KONS – Coordinated Care for Heart Failure. It was approved by Minister Szumowski and its commencement was announced, but it never really started. At the moment, there are new people and new concepts in the ministry, for example, piloting a cardiological network with, theoretically, planned care for patients with heart failure, but it is not exactly the same program as KONS. If we look at the KOS program – infarction, which applies to patients after a heart attack, it includes both cardiac rehabilitation and scheduled follow-up visits and check-ups, and even additional diagnostic or treatment procedures. KOS – myocardial infarction significantly reduced the mortality rate of patients after a heart attack, we already have the results. We look at him with envy because we are convinced that introducing a similar program for heart failure would be equally effective.

This may interest you:

1. What is your heart condition? A trivial test with stairs
2. The mistakes you make while you sleep. This is how you weaken your heart
3. Habits that increase the risk of a heart attack. Give them up for health