By Joseph Carrozza, MD, as told to Camille Noe Pagán
The words "heart failure" sound like a death sentence to many people. Oftentimes, they had a parent or grandparent who died of the condition, so it’s frightening. And the word "failure" makes it sound like a hopeless diagnosis. But it’s not. As I say to my patients, the treatments we have today are vastly different than those available even 5 years ago. Heart failure is a lifelong condition that you can manage. You can live a long, productive life with it, and do almost anything you were doing before your diagnosis.
On a Path to Treatment
When you have heart failure, it’s important to work with a cardiologist. They’re the best experts to help you manage your disease. Many of my patients come to me after their primary care doctors diagnose them or suspect that they have it. But sometimes another specialist, like a nephrologist (that’s a kidney specialist) or an endocrinologist
who treats diabetes, is the one to pick up on it. Less often, I see patients who developed heart failure after they had major surgery.
Some cases of heart failure are even reversible. For example, if a patient has a problem with a heart valve, fixing it may ease or even end their heart failure. Unfortunately, most people with the condition have had prior heart attacks, untreated valve disease, infections in their hearts, or other issues that have made their heart trouble permanent. As their doctor, I help them find medications, devices, and other treatment options to help them manage their condition.
New Options for Heart Failure
The past decade has led to incredible breakthroughs in medications as well as devices like left ventricular pacing, which helps the heart’s main pumping chamber push blood out to the body. One thing that has really gotten cardiologists excited is a class of medications called SGLT2 inhibitors. They lower blood sugar by causing your body to get rid of sugar through your urine. Doctors have prescribed SGLT2 inhibitors to treat diabetes for several years, but researchers recently realized that people with diabetes and heart failure who took them were being readmitted to the hospital for heart failure less often and living longer. Now we use them to treat heart failure, even in people who don’t have diabetes. They’re not right for everyone, but they’re the first type of drugs in several years that have been able to help people with heart failure live longer.
Your Actions Make a Difference
I can give you all the medicine in the world, but if you’re not living a healthy lifestyle, it doesn’t matter. To manage heart failure, you need to follow a low-salt diet, maintain a healthy weight and weigh yourself daily, use a CPAP machine if you have sleep apnea, and exercise. That’s one reason I encourage my patients to go to cardiac rehabilitation after their diagnosis. As a doctor, I try to give them as much information and attention as I can. And other health care providers, especially nurse practitioners, can help with education, too. But at a cardiac rehab facility, you can learn even more about nutrition, exercise, weight loss, how to manage stress, and, if you smoke, how to quit. Research shows us that addressing these things improves your day-to-day life and helps keep you out of the hospital.
I’ve seen patients at both ends of the spectrum. Some work hard to follow all of our recommendations, and 6 months to a year later, they’re different people. They feel great and they’re not developing other health problems linked to heart failure, like diabetes. Others get diagnosed and think, ‘I’ve got to die of something, so I guess I’ll enjoy myself while I can by eating what I want and not exercising.’ It becomes a self-fulfilling prophecy and they don’t do as well.
If you have heart failure, remember that it’s not a hopeless situation. You have so much control over how you feel and whether you’re going to be able to keep working, taking care of your grandchildren, playing golf, or doing whatever else is important to you. It’s all possible if you commit to a healthy lifestyle and view your relationship with your cardiologist and health care team as a partnership.
Joseph Carrozza, MD, chief of cardiology, St. Elizabeth’s Medical Center, Boston.