Heart failure is entirely preventable

35
Dr. dr. Isman Firdaus, Sp.JP(K), FIHA, FAsCC, FAPSIC, FESC, FSCAI, and dr. Siti Elkana Nauli, Sp.JP(K), FIHA, FAsCC, FHFA.
Dr. dr. Isman Firdaus, Sp.JP(K), FIHA, FAsCC, FAPSIC, FESC, FSCAI, and dr. Siti Elkana Nauli, Sp.JP(K), FIHA, FAsCC, FHFA. Photo: Esti/IO

IO – Cardiovascular disease is the number one cause of death worldwide. A study titled “Heart Failure across Asia: Same Healthcare Burden but Differences in Organization of Care”, published in the International Journal of Cardiology, reports that heart failure sufferers number 5% of the total population of Indonesia. Heart failure mortality rate is quite high: 17.2% of patients die during hospital treatment, 11.3% die within the first year of treatment, and 17% undergo repeat hospitalization, due to the worsening of symptoms. 

“Heart failure is a condition where the heart muscles are incapable of pumping out sufficient blood to cover the body’s blood and oxygen needs. It is a chronic and progressive illness. Heart failure is marked by repeated hospitalization due to steady worsening of the illness. If not handled properly, global death rate of the disease is estimated to increase to include more than 23.3 million sufferers in 2030,” said dr. Siti Elkana Nauli, Sp.JP(K), FIHA, FAsCC, FHFA, Head of the Indonesia Cardiovascular Specialists’ Association (Perhimpunan Dokter Spesialis Kardiovaskular Indonesia – “PERKI”) Heart Failure Task Force, in the “How to Prevent and Mitigate Cardiovascular Disease and Improve the People’s Awareness of Heart failure” webinar held on Saturday (29/01/2022). 

The risk of heart failure increases among sufferers of hypertension, coronary weakness, diabetes, those with a family history of cardiomyopathy, heart valve abnormalities, thyroid function disorder, metabolic syndrome, and those who are exposed to toxins, including smokers. Data in the Task Force Registry shows that the biggest contributing factors of heart failure are coronary weakness, hypertension, and diabetes, with additional risk factors being obesity, dyslipidemia, kidney function disorder, a sedentary lifestyle and obstructive sleep apnea. 

“There are 23 factors that worsen heart failure, including lack of rest. Staying up late is a risk factor, especially if a patient drinks coffee to enable themselves to do so. Large caffeine consumption increases the heart rate, which increases pulse speed. Higher pulse speed forces the heart to pump even harder, even though it is already in a bad condition. Furthermore, adrenaline usually increases when you lack sleep. It forces the heart to beat faster and work that much harder. It’s so bad, patients can die instantly,” dr. Siti Elkana said. 

Three Pillars of Treatment 

In Indonesia, the guidelines to responding to heart failure issued by PERKI in 2020 list the three pillars of heart failure treatment: RAS (renin angiotensin aldosterone) blockers, beta blockers, and MRA (mineral receptor antagonists). They must be used to respond to chronic heart failure as long as no counter-indication is found. Meanwhile, in late 2021, the PERKI Heart Failure Task Force issued a scientific paper concerning the recommendation of SGLT2-I as additional therapy for patients with left ventricle ejection fraction of ≤ 40% heart failure, ones whose declining condition has necessitated standard heart failure therapy to reduce mortality and risk of repeat hospitalization. 

She went on to declare that the primary purpose of treating heart failure patients is to prevent death or repeat hospitalization. It will also improve the quality of the patients’ lives. Furthermore, even though multiple options of therapy are available, prevention is still the most important. 

During the same event, Dr. dr. Isman Firdaus, Sp.JP(K), FIHA, FAsCC, FAPSIC, FESC, FSCAI, Head of PERKI Central Leadership Council, emphasizes PERKI’s role in educating both laypeople and health workers about heart failure. “It is important for us to prevent heart failure by living a healthy life: consuming healthy food, engaging in sports regularly, and consulting doctors on the right way to manage heart failure risk factors. We need to check the health of our hearts early, especially if we experience chest pains, rapid heartbeat, getting exhausted easily, swelling in the legs or difficulty breathing. The doctor will perform an initial non-invasive cardio check like echocardiography, Holter monitoring or a treadmill test,” he said. (est)