Health

Heart Failure and Older Adults – What You Need to Know

As an older adult, it’s likely that you or someone you know is living with heart failure — a condition that happens when the heart can’t pump enough blood to meet the body’s needs. This health condition is more common than you may realize, affecting more than 5 million people in the U.S. What’s more, over 80 percent of heart failure patients are age 65 and older — and heart failure is now the # 1 reason for hospitalization of older adults.

“As the baby boomer generation ages over the next two decades, it’s projected the number of people with heart failure will increase to about 10 million,” explains Ali Ahmed, MD, MPH, geriatrician and director of the Geriatric Heart Failure Clinics at UAB and the Birmingham VA Medical Center. “Heart failure is a serious condition affecting a large percentage of the older adult population. It must be carefully managed by a physician experienced in treating heart failure so that patients can live longer and enjoy the best possible quality of life.”

Understanding the Causes and Types of Heart Failure

There are two main types of heart failure, each with distinct characteristics and causes:

Systolic Heart Failure. With this type of heart failure, the heart is too weak to pump blood efficiently to the rest of the body. “About 50% of heart failure patients fall into this group,” observes Dr. Ahmed. The most common causes of systolic heart failure are heart attack, viruses, and alcoholism.

Diastolic Heart Failure. This type of heart failure, more common in older adults, causes the heart to become thick-walled, small, and rigid. As a result, the heart may not be able to fill up with enough blood.

Whether the heart is too weak to pump, as in systolic heart failure, or too rigid to fill up as in diastolic heart failure, the end result is a heart that fails to pump enough blood to the rest of the body.

Dr. Ahmed explains that the two most common causes of heart failure are heart attack and high blood pressure, both common in older adults.

“An acute heart attack, if massive, may damage a large portion of the left ventricle, the part of the heart responsible for pumping blood to the rest of the body. When this happens, the left ventricle may become large and thin-walled, and the heart becomes too weak to pump efficiently,” says Dr. Ahmed.

“High blood pressure or hypertension, when prolonged and uncontrolled, may also damage the left ventricle. When this happens, the left ventricular may become small and thick-walled, and the heart may be too rigid to relax and fill up with enough blood to pump efficiently,” Dr. Ahmed explains.

Diagnosis and Treatment

Dr. Ahmed stresses that because there is no single test to confirm heart failure, the diagnosis can often be difficult, particularly for older adults. “Older adults often have other conditions — depression, lung disease, deconditioning and obesity — which mimic the most common symptoms of heart failure: shortness of breath and fatigue.”

He also says many older adults attribute their symptoms to aging and don’t report them to their doctor. “As a result, we often see older patients with heart failure at a much later stage,” Dr. Ahmed observes. A diagnosis of heart failure is typically made based on patient history and physical examination, and may also be aided by laboratory tests, a chest x-ray or an electrocardiogram. “It’s important to understand that heart failure is a syndrome — not a disease. As such, we need to determine the underlying cause because if the underlying condition continues, the heart may continue to sustain damage.”

Dr. Ahmed also emphasizes that anyone who has been diagnosed with heart failure needs to understand the term ejection fraction of the left ventricle. “This is a number that tells you how strongly the heart is pumping. Also, this measure is used to determine the type of heart failure you have and how it should be treated.”

He says that in general, patients with systolic heart failure have an ejection fraction of less than 45%, which indicates a weak heart and a poorer prognosis. In diastolic heart failure, ejection fraction is higher is than 45%, which means that the heart’s pumping ability is typically strong but the heart still fails as a pump because it is too small and rigid to fill up.

Two groups of medications — ACE inhibitors and beta blockers — can help to prolong the lives of those with systolic heart failure. “ACE inhibitors work by widening blood vessels, lowering blood pressure and helping to decrease the heart’s workload. Beta blockers slow down the heart rate and contractions to enable the heart to pump for a longer period of time,” explains Dr. Ahmed. It isn’t currently known if these medications are effective in treating people with diastolic heart failure.

Key Lifestyle Measures

Following certain lifestyle measures can help people with heart failure deal with troubling symptoms — such as fluid retention and fatigue — and live a more active, healthy life.

Limit Sodium in the Diet. People with heart failure often retain fluid, which can be seen as swelling in the feet, ankles and legs. When fluid accumulates in the lungs, patients experience shortness of breath. Because sodium can contribute to fluid retention, it’s important for people with heart failure to limit the amount of sodium in their diet to less than 2,000 mg. per day. “The most important way to limit excess sodium is to avoid table salt completely,” says Dr. Ahmed.

Watch Fluid Intake. Drinking too much fluid can put excess strain on the heart. “In general, it’s fine for heart failure patients to drink between 1 1/2 - 2 liters of fluid in 24 hours,” Dr. Ahmed explains. This should include all fluid throughout the day, such as water, soft drinks, coffee, soup, etc.

Stay Active. While people with heart failure were once told to limit activity and “rest” their hearts, that advice no longer holds true. “We want heart failure patients to stay active as much as possible and as much as tolerated because it can help to increase endurance and minimize fatigue,” says Dr. Ahmed. “It’s also important that patients seek treatment for any conditions that interfere with their ability to be active, such as arthritis or depression.”