Heart Failure Awareness Webinar Series: Part 1 Recap
By Leigh Blander
As part of its heart failure awareness campaign, the HeartBrothers Foundation recently hosted a webinar featuring Massachusetts General Hospital Dr. Bin Yang, an advanced heart failure cardiologist.
“You are not alone if you have heart failure,” Dr. Yang said. “Heart failure is extremely common. Over six million Americans have heart failure and that number is projected to reach eight million by the end of the decade.” Dr. Yang added that 200,000-300,000 patients have advanced heart failure, and heart failure leads to $30 billion in medical costs each year.
Dr. Yang outlined the basic definition of heart failure.
“It is a clinical syndrome where the pumping ability of our heart is impaired. Our heart is not able to pump out the amount of blood our body needs. Patients may have had heart failure for many years and not have any symptoms. Over time, it can damage other organs and overwhelm our body's ability to adapt. Advanced heart failure is when the heart cannot meet the demands of the body. That’s when patients typically start to see doctors.”
Causes & Symptoms
The most common causes of heart failure are coronary artery disease (blocked arteries), high blood pressure, diabetes, viruses, inflammation, and drugs (including some chemotherapy medications).
Dr. Yang described heart failure symptoms.
“There is fluid accumulation in your lungs, body, legs… it can go to everything. Some patients may feel short of breath and wake up gasping for air.”
Patients may feel tired or lethargic, have discomfort in their chest, have irregular heartbeats or palpitations, and have a poor appetite.
“If you’re not feeling well, seeing your doctor is very important to start the process of diagnosing,” Dr. Yang said.
Your doctor may order several tests to determine if you have heart failure, including blood work, an EKG and an echocardiogram, which is an ultrasound of the heart.
“Once you’re diagnosed with heart failure, what happens next?” asked Dr. Yang. “We have a lot of different medications that can improve your heart failure, improve your quality of life and prolong your life expectancy.”
Dr. Yang explained that medications developed over the last 30 years have dramatically improved the lives of heart failure patients. The drugs are “additive,” he said, meaning each new drug will help on top of the previous one.
Patients with an ejection fraction (a measurement of how powerfully the heart is pumping) of less than 40 should probably be on the following, according to Dr. Yang:
A beta blocker
An SGLT2 inhibitor, like empagliflozin/Jardiance or dapagliflozin/Farxiga
If medications aren’t working and a patient develops advanced heart failure, a mechanical heart pump (left ventricular assist device or LVAD) or a heart transplant may be necessary.
“After LVAD, more than 80 percent of patients survive beyond three years. After a transplant, more than 50 percent of patients survive well more than 10 years. Pediatric patients do even better. LVADS and transplants are life-changing and life-saving therapies.”
Heart Failure in Underserved Populations
Dr. Yang also spoke about the heart failure crisis facing underserved populations.
“This is a really important topic,” he said. “We in our society have to do better. There is a higher incidence of obesity and high blood sugars in those patients. There are also socioeconomics, financial differences, [and] structural barriers to seeking care. It’s much harder for these populations to see a doctor.”
Dr. Yang acknowledged there is also bias in care.
“We know that African American and Black patients, when they’re in the ER and coming in with heart failure symptoms, they’re much less likely to be admitted to a cardiology unit. Even in the intensive care unit, African American patients with heart failure are much less likely to see a cardiologist. And in patients with heart failure, underserved populations are less likely to receive an LVAD or transplant.”
Q&A with Patients
Several heart failure patients attending the webinar asked questions, including what to do if you can’t tolerate a certain medication.
“We’ll try to lower the dose to what you can tolerate,” Dr. Yang answered. “A little bit is certainly better than nothing. If that doesn’t work, or if certain medications are too expensive, we have a lot of different substitutes. A lot of these medications are on the $4 list at Walmart and places like that. Hospitals and companies have programs to help afford these life-changing medications.”
Another patient asked if there is one thing people with heart failure should avoid.
“If you take in and eat a lot of sodium, you tend to hold onto a lot of fluid. I hate to tell everyone with heart failure not to have a nice meal. Everything in moderation,”
Prevention is key, Dr. Yang emphasized.
“We should all be trying to prevent ourselves from getting it in the first place by decreasing the rates of smoking, managing blood pressure aggressively, managing sugars.”
Finally, someone asked Dr. Yang why heart failure is often misdiagnosed at first.
“If you think about some of the symptoms – shortness of breath, fatigue, other nonspecific symptoms – these can come from the heart or the lungs or hormonal issues or if your thyroid levels are too low. It may take time for even experienced doctors to home in on the fact that it’s heart failure.”