Heart Failure

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One in ten Germans over 70 years of age lives with chronic heart failure and the related lower quality of life. Although the number of deaths due to heart failure has been falling since 1990, the incidence of the disease is rising steadily. In Germany, for example, heart failure is the most frequent cause of inpatient hospitalization: in 2016, 518 patients per 100,000 inhabitants had such severe heart failure that they were admitted to hospital. This is two per cent higher than in 2015. Women are affected less often than men.

Clinical picture

When the heart can no longer supply the body with sufficient oxygen-rich blood, this is called heart failure. In the case of systolic heart failure, this is because the pumping ability of the heart is limited. In the case of diastolic heart failure, the pumping ability remains, but the left ventricle is stiff and not adequately filled with blood. Both types of heart failure lead to shortness of breath, weakness, fatigue and a reduced ability to exercise. Fluid accumulation in the lungs and limbs also occurs because blood accumulates in the veins and lungs. Abnormal heart rhythms called ‘arrhythmias’ can also occur. Heart failure is a degenerative disease – it becomes increasingly worse and is divided into different stages.

Causes

Heart failure is caused by other diseases. Systolic heart failure is most often preceded by coronary artery disease (narrowing of the coronary arteries) and high blood pressure. However, heart muscle diseases, heart valve defects or chronic lung diseases can also be the cause. Diastolic heart failure also has various causes, including inflammation or thickening of the heart muscle. It is often accompanied by high blood pressure, diabetes, atrial fibrillation and obesity.

Therapy

Even in early stages, systolic heart failure is treated with drugs, e.g. ACE inhibitors, diuretics or beta blockers. These are designed to reduce symptoms, prevent hospitalization and improve survival rates. These drugs are not effective in diastolic heart failure, where the medication depends on the associated diseases. Recent studies show that patients with systolic heart failure benefit from regular physical training at moderate intensity. They become more physically resilient and there are fewer repeat visits to the hospital. Moderate means about one hundred steps per minute or 3,000 steps in 30 minutes. Co-ordinated physical training can also help patients with diastolic heart failure to increase their performance and well-being.

If heart failure is more advanced, a pacemaker may be necessary to prevent disordered beating of the heart. To protect against life-threatening arrhythmias, it may also be necessary to implant a defibrillator or cardioverter. These small devices deliver electrical impulses to help treat the dangerous arrhythmias. In the last stage, this is called terminal heart failure. The heart is so severely damaged that it is no longer able to pump sufficient oxygen-rich blood through the body, even at rest. Even without physical exertion, those affected feel shortness of breath, weakness and have a very low exercise capacity. For many, a heart transplant is the only chance of long-term survival. However, the waiting lists for a transplant are long, with patients waiting an average of 17 months. To bridge the waiting time and increasingly as a permanent solution, doctors are implanting a cardiovascular assist device (VAD). The DZHK is conducting the VAD-DZHK3 study for this purpose.

Further information on heart failure can be found at:

Competence Network Heart Failure
http://knhi.de/en/


Information regarding further Cardiovascular Diseases

Find information on the most important cardiovascular diseases researched at the DZHK and tips for their prevention.

Please note: The articles contain only general information and must not be used for self-diagnosis or self-treatment. They cannot replace a visit to the doctor.


DZHK studies on heart failure

The DZHK wants to achieve that cardiovascular diseases can be better detected and treated. Clinical studies are indispensable to achieve progress in this area. This is why the DZHK supports this research.

TransitionCHF-DZHK2 – Systolic dysfunction to congestive heart failure cohort study
FAIR-HF2-DZHK5 – Intravenous iron in patients with systolic heart failure and iron deficiency to improve morbidity and mortality
VAD-DZHK3 – Early versus emergency left ventricular assist device implantation in patients awaiting cardiac transplantation
CAVA-ADHF-DZHK19 – Ultrasound evaluation of the inferior vena cava in addition to clinical assessment to guide decongestion in acute decompensated heart failure: a pilot study 
Ex-VAD-DZHK11 – Exercise Training in Patients with Left Ventricular Assist Device
HFpEF-stress-DZHK17 – Cardiovascular magnetic resonance real time exercise stress testing in heart failure with preserved ejection fraction
Decipher HFpEF-DZHK12 – Validation of Cardiovascular Magnetic Resonance against Invasive Haemodynamics in Patients with Heart Failure with Preserved Ejection Fraction
SPIRIT-HF-DZHK8 –  SPIRonolactone In the Treatment for Heart Failure
METRIS-HF-DZHK18 – Effect of Metformin in insulin resistant patients with heart failure with reduced ejection fraction