“Heart failure represents a Cinderella condition in Europe,” said Professor Ulf Dahlstrom, chair of the Heart Failure Association’s committee on National Heart Failure Societies, who are co-ordinating the initiative. “One of the big problems we face is a lack of awareness about heart failure - people just don’t understand how serious this condition is or the fact that it is often fatal. Much more education is needed for the public, patients with heart failure and health professionals.”
Heart Failure is estimated to affect 28 million people in Europe, around 2 to 3 % of the total population. A further 2 to 3 % of people in Europe are estimated to have asymptomatic left ventricular dysfunction, a condition that can all too easily develop into symptomatic heart failure if sufferers develop infections. Patients diagnosed with heart failure are estimated to have a 50 % chance of surviving five years, a prognosis that is similar to many common cancers. Furthermore, for people aged over 65 studies show that heart failure represents the most common reason they are admitted into hospital.
“While there is no cure for heart failure, the good news is that if people get the correct diagnosis and treatment this can have an enormous influence on their survival, quality of life and need for hospital care,” said Dahlstrom, who runs a heart failure clinic at Linkoping University Hospital (Linkoping, Sweden).
But all too often patients with suspected heart failure are not being offered diagnosis or treatment according to European Guidelines. A retrospective study of 2000 heart failure patients, from 158 randomly selected primary health care centres in Sweden, found that only 30 % had undergone diagnosis with echocardiography (1). Current European Guidelines state that the diagnosis of heart failure should be confirmed by objective evidence of cardiac dysfunction, preferably by echocardiography. Furthermore the study, published in 2009, showed that 60 % of people thought to have heart failure were not being prescribed optimal treatment with renin angiotensin system blockers (RAS) or beta blockers. There is no reason to assume, said Dahlstrom, that patients are faring any better in other European countries.
“There are real concerns that if people aren’t being diagnosed correctly, some people will be treated who don’t have the condition, exposing them to the possibility of serious side effects without any benefits. It needs to be remembered that these are powerful drugs that can cause electrolyte disturbances, arrhythmias, and reduced renal function,” said Dahlstrom.
One way to improve the situation is to establish more specialist heart failure clinics across Europe, where heart failure patients can be seen by doctors and nurses specialising in heart failure, and have access to state of the art investigations. “Ideally, many of us would like to see every hospital offering such clinics,” said Dahlstrom.
Studies have shown that treatment in specialist clinics improves mortality, morbidity and self-care behaviour for heart failure patients. “Clinics ensure that patients have the correct diagnosis, optimise treatment according to Guidelines and educate and involve patients in their condition so that they can recognise the symptoms of worsening heart failure,” said Dahlstrom. In 2009 the ESC launched the pilot European Heart Failure registry in 12 countries. Such registries, said Dahlstrom, show whether participating units are following recommended Guidelines on the diagnosis and treatment of heart failure, and create a platform for open discussion. “We have real hopes that once health professionals see how their service compares to other centres it will provide a real incentive for improvement,” said Dahlstrom.
One important aim of the weekend will be to identify people who may not know that they are suffering from heart failure. The public are being asked to consider the following question: “Do you have unexplained shortness of breath, swollen ankles?” For anyone answering “yes”, a four step plan can be brought into place. The first step is to get further information (from the patient website http://www.heartfailurematters.org/). The second (if they are still concerned) is to contact their GP. The third is to have a proper diagnosis, which should include blood tests for measuring biomarkers (such as brain natriuretic peptide) and if positive echocardiography to evaluate cardiac function. The fourth is to get treatment – Guidelines say that heart failure patients should be treated with beta blockers and ACE inhibitors.
Initiatives for this European Heart Failure Weekend, include heart failure clinics providing open days to show how they work, case echocardiography to the public, lectures for the general public on subjects such as what is heart failure, how can it be diagnosed and treated, the importance of healthy diets, debates about the need for heart failure clinics, and fitness demonstrations, such as Tai Chi, to highlight the fact that people who have heart failure can still be active and benefit from exercise.