Lifestyle changes help ease heart failure symptoms

(Third of a series)

Heart failure (HF) puts a heavy burden on patients and their families. HF markedly affects patients’ quality of life. Fear, anxiety and depression are common. Work, travel and day-to-day social and leisure activities are difficult for HF patients with breathlessness and extreme fatigue.

In the previous column, we discussed the different medications that help HF patients improve their survival rate and quality of life. Compliance to prescribed medications enable patients to enjoy relatively active lives.

Despite improvement in survival rates with current therapies, patients with HF have a poor prognosis. Half of all patients will die within five years of being diagnosed with HF.

In the previous article, we discussed how a complex hormone system called the renin-angiotensin-aldosterone system (RAAS) activates several mechanisms to compensate for the failing heart. Unfortunately, these temporary compensatory measures eventually become detrimental to the patient.

A novel strategy for treating HF is sacubitril-valsartan which enhances the heart’s protective neurohormonal system (NP system) while simultaneously suppressing the harmful system (RAAS). It amplifies the natural defense response of the heart, while inhibiting the harmful effects of long-term RAAS stimulation—ultimately leading to reduced strain on the cardiovascular system.

Some patients with HF have a life-threatening abnormal heart rhythm which can happen suddenly and unexpectedly. Sometimes people die as a result of this. These patients may require an implantable cardioverter defibrillator (ICD). An ICD is a small device that can give the heart electric pulses or shocks to get the heart rhythm back to normal.

Lifestyle changes

Following the recommended lifestyle change improves patients’ symptoms as well. The patient thus constitutes an important part of the management of the disease.

• If you smoke, stop. Avoid secondhand smoke, too. Smoking damages the blood vessels, elevates the blood pressure (BP), reduces the amount of oxygen in your blood and makes your heart beat faster.
• Monitor and record your weight. It is important for patients with HF to keep their ideal weight. An increase in weight of about

3 pounds, which may signal fluid retention, should prompt consult with the doctor. Check also for any swelling in your legs, ankles or feet daily.

• Eat a healthy diet that includes fruits and vegetables, whole grains, fat-free or low-fat dairy products and lean proteins. Restrict salt in your diet. Too much sodium contributes to water retention, which makes your heart work harder and causes shortness of breath and swollen legs, ankles and feet. Restrict water intake to avoid further water retention, especially those with severe HF.
• Say no to alcohol. Alcohol can interact with your medication, weaken your heart muscle and increase your risk of abnormal heart rhythms.
• Moderate aerobic activity, such as walking, helps keep the rest of your body healthy and conditioned, reducing the demands on your heart muscle in the long run. Talk to your doctor first before you start exercising. A hospital-based cardiac rehabilitation program may be helpful for you.
• Find ways to reduce stress. Stress or anxiety makes your heart beat faster, makes you breathe more heavily and your blood pressure to go up. These can make HF worse.
• To improve your sleep at night, prop up your head with pillows. If you snore or have had other sleep problems, make sure you get tested for sleep apnea.
• Follow up with your doctor regularly for adjustment of the doses of your drugs to reach the recommended target doses. Older patients or patients with kidney disease may require more frequent visits and laboratory monitoring during dose titration. More gradual dose changes are recommended for these patients. Changes in BP or heart rate may be more pronounced in these patients with changes in position.
• Talk to your doctor about the timing of medication intake, especially diuretics. Taking diuretics earlier in the day may decrease the need to urinate as often during the night and allow you to get more sleep.
• Some medications can exacerbate HF symptoms. It is important to consult your doctor before adding any medicine to your current treatment. Sudden discontinuation of prescribed medications by the patient is discouraged as this may cause patients’ breathlessness, as well as other symptoms to return.
• It is imperative to educate patients and family members about the expected benefits of following the recommended treatment. It should come with understanding the potential effects on increased survival, improved functional status and quality of life.

(Dr. Alex T. Junia, president of the Philippine Heart Association 2015-2016, completed his medical degree at Cebu Institute of Medicine and finished his Fellowship in Cardiology at the Philippine Heart Center. The PHA is an organization of cardiovascular specialists and lay members that ensure accessible, affordable and quality cardiovascular education and care for everyone. For more information, visit www.philheart.org.)