The Epidemiolody of a Heart Failure in the Elderly

September 7, 2015

Heart failure develops over time when the pumping capacity of heart diminishes and it is not able to supply enough blood and oxygen to support other organs in the body. It is usually called a geriatric syndrome as most of the heart failure patients are the older adults. It is also a serious cardiac syndrome that can affect either just the right side of the heart or both sides of the heart.  In some cases the heart is unable to fill enough blood while in the other cases the heart is not able to pump blood to the rest of the body with adequate force.   Heart Failure in Seniors - CausesEven though it is a serious condition that requires medical attention and care, it does not mean that in an event of failure, the heart has stopped or is about to stop beating. Right-side heart failure may cause the fluid to build up in the feet, ankles, legs, liver, abdomen and the veins in the neck. The heart failure on both the left and the right side of the heart can also cause shortness of breath and fatigue.

According to a report an estimated 2 million people in the United States have congestive heart failure (the CHF) each year and approximately 400,000 new cases occur. The prevalence of CHF increases dramatically as the person grows older. It is estimated that 9.1% of people 80+ years have congestive heart failure. Currently in the US, 33 million people are 65 years of age and 7.9 million are more than 80 years old. As such, even with conservative estimates there will be 3.6 million elderly with CHF. But these numbers significantly undermine the prevalence of milder CHF because the clinical criteria tend to be insensitive for the elderly patients.

The leading causes of heart failure are the diseases that damage the heart viz. Coronary heart disease (CHD), high blood pressure and diabetes. Apart from these, there are certain factors that lead to a heart attack or a heart failure:

  • Hypertension – also called the high blood pressure is a condition in which the arteries have persistently elevated blood pressure. Every time the human heart beats, it pumps blood to the whole body through the arteries.
  • Smoking – people who smoke regularly run a significantly higher risk of developing heart failure compared to a lifetime non-smokers and those who give up smoking.
  • Atrial fibrillation – increases with age and is associated with cardio embolic strokes, one of the most common strokes in the elderly that affects almost 10% of >80+ population. It is an irregular and often rapid heart rate that most commonly causes poor blood flow to the body. The symptoms often include heart palpitations, shortness of breath and weakness. It can lead to blood clots forming in the heart that may circulate to other organs. Almost over 2.3 million people in the US currently suffer from it and this number is projected to increase from 5.6 to 12.1 million by 2050.
  • Valvular pathology – also called valvular heart disease is characterized by a defect in one of the four valves of the heart – the mitral, aortic, tricuspid or pulmonary. Normally the valves ensure the blood flow with proper force in the proper direction at the proper time. But in the valvular heart disease the valves become narrow and hardened and are unable to open and close completely. The severity of the valvular diseases varies. In mild cases, there may be no symptoms, but in advanced cases, the disease can lead to the congestive heart failure and other complications.
  • Cholesterol – High blood cholesterol is one of the major risk factors for heart disease. When there is too much cholesterol level in a person’s blood, the walls are built up around the arteries. Hence over time, this buildup causes hardening of the arteries that makes them narrow, blocking the blood and the oxygen flow to the heart. Therefore, lowering cholesterol numbers lessens the risk of developing a heart disease and reduces the chances of a heart attack.
  • Diabetes Mellitus – is a well-known risk factor for stroke in the elderly population, yet this risk is not understood or realized by the patients with diabetes. This likely reflects a lack of understanding within the medical community of how it confers the risk for stroke. Almost 6.3% of the US elderly population are diabetic, but they account for 15-27% of all incident strokes, which certainly is an underestimation, as most studies classify patients having diabetes only if they were diagnosed before the stroke.

Heart failure is an end-stage of most heart diseases when the patient is more likely to be terminally ill. A high percentage of these patients die from cardiac causes,  but often the family and caretakers are unaware of the prognosis. The functional capacity is lost gradually making the recovery all the more harder. It is a major public health problem with a patient population of approximately 5 million in North America.

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