Heart Failure

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One in ten Germans over 70 years of age lives with chronic heart failure and is thus severely restricted in his quality of life. Although the number of deaths due to heart failure has been falling continuously 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. Compared to 2015, this number has thus increased by two percent. 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, this remains, but the left ventricle is stiff and not adequately filled with blood. In both forms, affected persons suffer from shortness of breath, feel weak, fatigue and have a reduced ability to exercise. Fluid accumulation in the lungs and, for example, in the arms and legs also occurs because the blood accumulates in the veins and lungs. Cardiac arrhythmias can also occur. Heart failure becomes increasingly worse and is divided into different stages.

Causes

Heart failure is the consequence of 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 the 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 ineffective in diastolic heart failure, where the medication depends on the concomitant diseases. Recent studies show that patients with systolic heart failure benefit from regular physical training at moderate intensity. They become more resilient and there are fewer repeat visits to hospital. Moderate means about one hundred steps per minute or 3,000 steps in 30 minutes. Coordinated physical training also helps patients with diastolic heart failure to increase their performance and well-being.

If the disease is more advanced, the implantation of a pacemaker may be necessary to prevent asynchronous contractions 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 stop 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, are weak, have a very low exercise capacity and are laid up. 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 for a transplant. 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/