About 5 million people in the U.S. have heart failure, according to the American Heart Association. A chronic and progressive condition, heart failure occurs when the heart muscle can no longer pump enough blood to meet the body's needs. Symptoms may include swelling in the feet, ankles, and legs, tiredness, and shortness of breath. It is usually treated with medications aimed at relieving symptoms and helping the heart do its job.
One new study shows that people with heart failure are also at a 30% increased risk for major fractures. As a result, they may benefit from screening and treatment to make sure their bones stay strong. This study appears in Journal of Clinical Endocrinology & Metabolism.
The second report shows that people with heart failure may have memory problems and a loss of grey matter in their brain. These changes may make it more difficult for people with heart failure to take their medications as directed. The findings appear in the European Heart Journal.
Be Aware of Patients' Limitations
Martha Grogan, MD, says the new studies tell us two important things about heart failure that we didn’t know before. Now “we need to think more about screening for osteoporosis and preventing fractures in people with heart failure. We also need a heightened awareness of the [mental] limitations of these patients.” She is an assistant professor of medicine at the Mayo Medical School in Rochester, Minn.
Heart failure often involves a complex treatment regimen that can be difficult to understand. Grogan likes patients to have a family member or caregiver at doctor appointments to understand the medications, the rationale for taking them, and the importance of being consistent on doses.
Richard S. Isaacson, MD, agrees. He is a neurologist at the University of Miami School of Medicine. “People with heart failure are going to have trouble understanding because their thinking skills are not as strong as they used to be. They often have multiple medical problems and difficulty understanding what they can do to help themselves,” he says. Handouts explaining heart failure and its treatments can often help remind people what they need to do and why they need to do it.
In the second study, Australian researchers ran mental tests on 35 people with heart failure, 56 people with another type of heart disease, and 64 healthy people. They also used magnetic resonance imaging scans to look at differences in the volume of grey matter in the brain.
People with heart failure had more problems with their immediate and long-term memory and had slower reaction speed than their healthy counterparts. The brain changes occurred in areas of the brain linked to demanding mental tasks and emotional processing.
Exactly why this occurs is not yet understood, the study authors report.
Heart Failure and Fracture Risk
In the fracture study, researchers looked at more than 45,000 adults undergoing bone mineral density testing for the first time and followed them for up to 10 years. Of these adults, 1,841 had recent-onset heart failure in the past two years. These individuals had an associated 30% increase in major fractures compared to people without heart failure. The fact that they had recently been diagnosed with heart failure suggests the increased risk for fractures may develop even before the heart failure.
“This is the first study to convincingly show people with heart failure have more osteoporosis than the general population,” says researcher Sumit R. Majumdar, MD, MPH. He is a professor of medicine at theUniversity of Alberta in Edmonton, Alberta, Canada.
Exactly why this occurs is not known, but there are many possibilities. Heart failure and osteoporosis share certain risk factors such as older age, smoking, and diabetes. People with heart failure also tend to be frail, which places them at greater risk for falls.
Knowledge is power, Majumdar says. The best thing to do is go over all medications with your doctor and discuss what you can do to protect your bones. This may include screening tests, taking calcium and vitamin D supplements, and taking medication if you have already sustained a fracture.