The process of ageing represents the declining functional capacity of the body. The body processes are deranged, and the organs gradually wear and tear. The cardiovascular system to renal functions or digestive system, all start showing lower performance levels. People develop one or more chronic diseases. These natural occurrences affect the individual's quality of life and require careful management of the disease.

To increase awareness about the lesser talked topic in older adults and otherwise: Heart Failure and its Management, The Times of India took the initiative called Beat Heart Failure in partnership with Novartis and conducted multiple discussions with the specialist's doctors from the best hospital of our country, to educate masses about the sign & symptoms, treatment options and management of heart failure.

Heart failure is the gradual weakening of heart muscle resulting in an inefficacious blood supply to the body. It is often thought to be a disease of the elderly because most hospitalisations and deaths, due to cardiovascular ailments are reported among the age group of seventy years or above. Studies have revealed that heart failure rises almost ten to twelvefold in those above eighty years to eighty-nine years of age.

The inherent protective mechanism of the cardiovascular system wanes with age. Ageing results in an increase in cardiovascular disease and a decrease in cardiac reserve simultaneously besides the repair processes designed to deal with these problems become less and less effective. These factors combined inevitably and progressively set in the process of heart failure.

Structurally, the heart thickens and stiffens with age resulting in the increased limitation and imposition of several functional demands. Functionally, several inherent changes which assist the resting heart to deal with the effects of ageing cause significant working deficits with exercise or stress, thereby lowering the cardiac reserve.

Fatty plaques adhering to blood vessels narrow the coronary arteries due to genetics, other health problems, and poor lifestyle. If the heart muscle receives insufficient blood, this condition in a person is known as Ischemic heart disease. Ischemic heart disease may be asymptomatic or symptomatic, including symptoms such as angina pectoris or, in simpler words, chest pain, and pressure or squeezing.

One of the common conditions which accompany heart failure is renal insufficiency. A condition where the kidneys cannot filter blood compared to normal kidneys that cause more burden on the heart intensifying slide to heart failure. Most heart failure patients experience symptoms such as lack of control over urination or increased frequency and urgency.

The patients develop swelling in the legs, especially feet and ankles, abdomen. The swelling ensues due to the build-up of fluid in the body. Cardiac failures develop commonly in diabetics and are also linked to damage to the heart muscles, known as cardiomyopathy. Uncontrolled diabetics are more prone to heart disease. However, heart failure may also develop due to high blood pressure or narrowed arteries in the heart.

The number of patients with heart failure and preserved ejection function is increasing and is likely to continue to grow with the ageing of the general population. Although systolic dysfunction is present in at least half of CHF cases, the presence of a normal or elevated ejection fraction is more common in older heart failure patients, particularly women and those with atrial fibrillation and hypertension.

The patient and their attendants are asked to regularly check blood pressure, body weight, and pulse rate. Evaluation of the older patient presenting with cardiac failure symptoms includes routine blood investigations such as blood sugar level, kidney function tests. Investigation for common co-morbidities is also helpful as they are frequent and associated with increased hospitalisations and adverse clinical outcomes.

Other investigations consist of electrocardiogram, chest x-ray, two-dimensional echocardiography. If the healthcare provider finds any deviation in the results, they recommend further detailed studies. Investigations of reversible precipitants such as anaemia, infection, thyroid disease, atrial fibrillation, dietary or medication non-compliance, and hypertension are helpful in new-onset heart failure patients.

In the older heart failure population, exertional symptoms are less common, and those related to fatigue and mental status changes are more common. Although patients may carry the same heart failure diagnosis, they differ markedly in terms of disease severity and complexity, associated co-morbidities, social support, education, ingrained habits, access to medical personnel and knowledge, and understanding of health care information and directions. The treatment is guided on a case-by-case basis.

Non-compliance with medications or diet is often cited as a significant factor contributing to the hospitalisation of heart failure patients. However, in older patients, non-compliance is more likely due to social isolation, financial difficulties, limited travel, and meal options decreased tolerability for some medicines, co-morbidities, and difficulty following defined medical regimens.

In many of these patients, a multidisciplinary team approach, including simplifying the medical regimen, close monitoring, and intensive patient education, can decrease hospital admission and improve quality of life. Remember, heart failure isn't about stopping. It's about starting life in a new way.