Continued improvement in medical and device therapy for heart failure has led to better survival with this disease.

Longer survival and increasing numbers of unhealthy lifestyle factors and behaviours, leading to the occurrence of heart failure at younger ages, are both contributors to an increase in the overall prevalence of heart failure. When a person has heart failure, it means that the heart isn't pumping blood as well as it should be.

The doctor may recommend lifestyle changes as part of treatment, as lifestyle changes can play an important role in heart failure management. They can slow the progress of the disease and help patients feel better. They can also decrease the impact of the disease on day-to-day life. Healthy choices can ease symptoms and help with conditions that make heart failure worse, like high blood pressure and diabetes.

Due to the lack of knowledge about the disease, the patients come in very late, resulting in restriction of treatment. To create awareness about heart failure, its management and treatment options, The Times of India launched Beat Heart Failure in partnership with Novartis. Specialised doctors from the best hospitals of India have also contributed to this initiative by disseminating their knowledge, providing guidance and creating a word of caution for all to take Heart Failure seriously.

In the fourth phase of the campaign, doctors from Narayana Multi-specialty Hospital, Jaipur have joined the discussion with an objective to explain the identification of heart failure with new management options available. The key members of the discussion were:

1) Dr Devendra Shrimal, Sr. Consultant - Cardiology

2) Dr Nikhil Choudhary, Sr. Consultant - Cardiology

3) Dr Ankit Mathur, Sr. Consultant and Cardiac Surgeon

The term heart failure can often be confusing for people as the word failure relates to things that may end soon, remarked Dr Nikhil. Heart Failure, in proper terms, means the gradual weakening of the heart resulting in decreased ability to supply blood according to the body's requirement. It is a gradually progressive disease.

Heart failure results in multiple symptoms such as gradually increasing breathlessness that was not present earlier. Dr Devendra further elaborated on the genesis of symptom presentation in heart failure and said that a patient will complain of difficulty in breathing while lying down, which subsides whenever the person sits or wakes up at night with suffocation.

The patient has difficulty in sleeping and puffiness in the body with decreased appetite and urine output. The patient may gradually require oxygen support in the end-stage if left untreated. Dr Mathur explained that in elderly people, common causes for cardiac failure are diabetes, hypertension, and coronary artery disease. In the younger population, it is an infection, congenital defects, deficiency of vitamins or minerals, and restrictive diseases.

In India, the major contributing factor is also a poor lifestyle. The one-third population has uncontrolled heart failure, and only one-third of the affected population is taking treatment. Dr Nikhil added that in India, a poor lifestyle is a major cause of heart failure. For a better understanding of heart failure, Dr Nikhil classified heart failure into two identities based on reduced ejection fraction ischemic cardiomyopathy and non-ischemic cardiomyopathy.

More than 50% of cases of heart failure are due to ischemic cardiomyopathy, where there is a blockage in the heart and due to that heart is not been able to supply adequate blood to the body. The major risk factors in ischemic cardiomyopathy could be diabetics, hypertension, dyslipidemia and family history. Whereas non-ischemic cardiomyopathy occurs due to other reasons and not because of blockage in the heart. It is primarily seen in patients with chronic alcohol intake, congenital heart disease, and viral myocarditis.

Since poor lifestyle is the major cause of heart failure in India, doctors strictly advise to adhere to lifestyle modifications and in case of occurrence of heart attack, the patient should be taken immediately to the hospital during the golden hour to preserve heart muscles. After a person is diagnosed with heart failure, compliance is necessary. The patient needs to restrict the fluid and salt intake. The doctors begin with medical management. The focus of the cardiologists is to fix the cause and associated symptoms to prevent hospitalisation.

The patient requires proper counselling and lifelong treatment. It begins with controlling the risk factors to prevent the disease progression. Suppose a patient comes with pedal oedema and congestion in the chest, it is known as Wet heart failure, in that case, the doctor's plan of action includes an increased urine output.

Managing risk factors such as hypertension, diabetes, etc., requires lifestyle modification. Active lifestyle, i.e., a physician-guided physical activity, is beneficial. Sixty to seventy per cent of patients require aggressive medical therapy known as pillars of heart failure management. The medicines are given lifelong and require constant titration of the dose.

Suppose the patient does not benefit from medical therapy. In that case, surgical options are recommended that include cardiac resynchronisation therapy devices, and end-stage heart failure requires a left ventricle assist device or a heart transplant. The doctors try to prevent re-hospitalization as every time a patient is hospitalised, it puts a toll on the body and morale of the patient.

The doctors ended the discussion with a positive message that though heart failure is a gradually developing disease, still, proper treatment and timely interventions may help control the progression of the disease. Patient compliances in medications and follow-ups are necessary. Remember, heart failure isn't about stopping. It's about starting life in a new way. To know more about how to manage heart failure, visit www.toibeatheartfailure.com

Disclaimer: The views and opinions expressed in the article by the panellists/experts are based on their independent professional judgement and are disseminated in the public interest. These views should not be considered as a substitute for the professional advice of a registered medical practitioner. The purpose of this article is not to promote any medical procedures or medication and/or recommend a certain doctor. For any specific health issues, please consult your registered medical practitioner.