Caring for someone with heart failure (HF) can be stressful and scary and may lead to a lot of questions. Learning about the disease and how it progresses will prepare you to help your loved one manage their symptoms.
What is Heart Failure?
When someone has HF, it means their heart is too weak to pump enough blood to meet the body’s need for oxygen. In some cases, the heart simply cannot pump with enough force. In others, the heart cannot fill with enough blood. This can cause a serious interruption to the flow of the entire circulatory system. While heart failure can affect one side of the heart or the other, most cases eventually progress to involve both sides.
Congestive heart failure (CHF) is often used interchangeably with HF, but CHF is a specific type that is very serious. It occurs when the circulatory system is so compromised that blood and other fluids gather in certain areas of the body, congesting tissues. This can lead to edema (swelling) in the lower extremities, the abdomen and even around the lungs. When fluid collects around the heart, lungs and other internal organs, it can cause serious symptoms that must be closely monitored.
What Types of Doctors Treat Heart Failure?
Your loved one may receive treatment from a general practitioner (GP) or family medicine physician (FMP) at first. However, as symptoms progress, they will probably make referrals to one or more specialists who have specific qualifications and more experience working with patients who have heart failure.
Internists (doctors who specialize in internal medicine for adults) may manage treatment in conjunction with a cardiologist. Cardiologists specialize in diseases that affect the heart and blood vessels, so they are often involved in treatment, especially as heart failure progresses. Some cardiologists have received advanced training and specialize in treating heart failure. Other specialists you may encounter include cardiac surgeons and cardiac electrophysiologists, who specialize in heart rhythm problems.
What Are the Different “Stages” of Heart Failure?
HF is generally organized in four “classes” or stages. Patients can only move forward in the stages, not backwards. Below you will find an explanation of what symptoms, tests and treatments are involved in each stage.
Someone who smokes, abuses alcohol, eats a high-fat diet or has a family history of heart problems, diabetes or high blood pressure (hypertension) may be considered at risk for class A heart failure. However, a patient in this stage does not show any symptoms and does not experience any limitations in ordinary activities.
A senior who has been diagnosed with class A HF will generally need to monitor and manage their blood pressure and cholesterol to prevent further cardiovascular damage. They may also be prescribed medication and lifestyle changes to help get and keep these things under control.
Doctors will likely order cholesterol and C-reactive protein (CRP) blood tests and may also order chest x-rays and/or electrocardiogram tests to confirm the diagnosis. Because patients do not show any symptoms at this stage, seniors can continue to maintain an active lifestyle. Becoming more physically active (as they are able), quitting smoking, and lowering or discontinuing alcohol use may help to slow the disease’s progress.
With a class B diagnosis, there is some evidence of cardiovascular disease. The patient shows mild symptoms and some slight limitations during ordinary activities but is comfortable at rest.
Doctors will want to continue monitoring blood pressure carefully. Additional chest x-rays, electrocardiograms, blood tests and/or echocardiograms may be performed to aid in the diagnosis. Stress tests, MRIs or CT scans may also be required.
More aggressive medications may be prescribed to keep blood pressure and cholesterol in check, including ACE inhibitors and beta blockers. Doctors may also discuss possible surgical options for coronary artery repair and heart valve replacement or repair.
Seniors with class B heart failure can still be fairly active. They may experience shortness of breath more frequently than before, so they should be mindful to not over-exert themselves. When done responsibly, moderate activity at this stage can still help slow the disease’s progression.
A patient in class C heart failure shows increasing evidence of moderate to severe cardiovascular disease. At this stage, the patient encounters obvious limitations in their daily routine due to their symptoms. Ordinary activities result in fatigue, heart palpitations or labored breathing, and the patient is typically only comfortable while resting.
The same diagnostic tests used for classes A and B are used to diagnose this class of heart failure. Doctors may also request coronary angiograms and/or myocardial biopsies to diagnose or rule out certain types of heart muscle diseases. In addition to the treatment options described above, doctors may also recommend cardiac resynchronization therapy (a pacemaker) and implantable defibrillators.
Those in class C often find they are unable to be very active because of their symptoms and should discuss safe exercise options with their doctors.
A person with class D heart failure shows objective symptoms of severe cardiovascular disease and is significantly limited in their activities. Unlike the previous stages, they will continue experiencing symptoms even while at rest.
Treatment options for advanced heart failure are growing and may include such things as implantable defibrillators, which shock a “fluttering” heart back into normal action, or mechanical heart pumps, which can relieve shortness of breath and other congestion-related symptoms. However, there are risks associated with these options, and they may outweigh the potential benefits for some seniors.
Different types of open-heart surgery are also considered for treating some class D heart failure patients, but this type of invasive treatment comes with substantial risk. Unfortunately, many seniors are not good candidates for this option. Patients in this advanced stage may also receive continuous medication through the use of IV drips and may need palliative or hospice care to achieve comfort.
Commonly Prescribed Medications for Heart Failure
ACE (angiotensin-converting enzyme) inhibitors, beta-blockers and diuretics are commonly associated with the treatment of heart failure. As a loved one’s HF progresses, they may be given more medications to help improve and regulate the function of their heart and circulatory system. Nitrates, statins and blood-thinners can also be added to their regimen to manage chest pain, cholesterol levels and blood clotting respectively.
While you and your loved one should speak extensively with their health care team about their medications, there are a couple of important things to know about a few of the above drugs.
ACE inhibitors can interact with other medications, like NSAIDs (nonsteroidal anti-inflammatory drugs) and antacids, resulting in kidney injury, especially for those who already have compromised kidney function. These drugs can also cause hyperkalemia, or elevated levels of potassium in the blood.
Common side effects of beta-blockers include cold hands and feet, fatigue, dizziness and dry mouth. Recent studies also suggest that taking beta-blockers can potentially affect a patient’s mental state and mood as well.
Since diuretics help the body to eliminate excess water through urination, it comes as no surprise that depletion of some important minerals, like sodium and potassium, can occur during this course of treatment. If your loved one is taking a diuretic and an ACE inhibitor, for example, their doctor should carefully monitor their blood-potassium levels. Dizziness and dehydration are common side effects that can turn serious very quickly.
These medications are prescribed to reduce overall stress on a person’s heart, but certain combinations of these and others can result in a slowed heart rate (bradycardia), a drop in blood pressure (hypotension) and irregular heartbeat (arrhythmias). If your loved one experiences any of these symptoms, it is wise to contact their physician immediately.
How to Track Symptoms and Treatments Through the Stages
Caregivers can easily monitor a loved one’s blood pressure (BP) and heart rate at home using a blood pressure cuff and heart rate monitor. Keep track of BP changes, weight changes, and fluctuations in physical activity level/ability. Doing so will help the doctor monitor their condition and adjust their treatment as needed.
What is the Prognosis for Someone with Heart Failure?
When people begin exhibiting HF symptoms (class B), average life expectancy drops to less than five years. For those with class D heart failure, the prognosis is much worse. Ninety percent of advanced heart failure patients have survival rates of one year.
However, remember that statistics are just statistics. An individual’s prognosis will depend on a variety of factors. While it’s important to be realistic, it’s also important not to be overwhelmed or discouraged by the numbers.
Diet and Nutrition Tips for Seniors with Heart Failure
Regardless of what class a patient is currently in, there are some dietary changes that can help with symptom management and progression of the disease, including:
- Eating lots of fruits and vegetables
- Choosing lean proteins like skinless chicken and fish when possible
- Limiting sodium intake to 1,500 mg daily
- Choosing low-fat milk and other dairy products
- Choosing whole-grain and high-fiber foods
- Lowering alcohol consumption
- Lowering consumption of sugar and saturated fats
Rather than using salt and high-sodium dressings, condiments and sauces to flavor foods, opt for spices, herbs and aromatic ingredients, like garlic, carrots, celery, rosemary, ginger, thyme, parsley, citrus, etc. Avoid using pre-mixed seasonings and spice blends as well, since most of them already contain salt.
Monitoring Fluid Intake
We constantly hear about how important it is to stay hydrated and consume enough fluids, but for someone with heart failure, this can be a difficult balancing act. Dehydration is never good, but excess water can put unnecessary stress on an already compromised heart. If the doctor recommends limiting a loved one’s fluid intake, there are a few ways to simplify this process.
First, remember that fluids don’t just consist of beverages like water, juice and soft drinks. Anything that melts or contains a large amount of liquid, like ice cream, popsicles and soup, counts toward your loved one’s daily intake. (Even a tricky item like gelatin counts!)
In order to minimize the likelihood that your loved one will become especially thirsty and exceed their intake limit, try to space out their liquids throughout the day. Smaller, more frequent servings can help with this. If they still have an issue with thirst, sugar-free chewing gum and hard candies can provide relief without drinking. Swishing with water and then spitting it out can also help. If dry mouth is exacerbating their feelings of thirst, special rinses and oral care products are available to remedy this.
If your loved one typically sticks to water, then use a marked container or pitcher in the refrigerator that holds their exact daily allowance. If they enjoy other beverages, like coffee in the morning or a glass of juice with dinner, then note the volume of liquid your mugs and glasses hold and be sure to deduct that from their daily total in the container. As part of their care plan, you can create a log sheet and record their intake throughout the day. Careful supervision and organization can prevent excess intake and adverse effects that can lead to hospitalization.
To read more HF tips from peers and elder care experts or post your own question about caring for a loved one with heart failure, visit the AgingCare.com Heart Disease Support Group.
Sources: 1. http://www.heart.org/HEARTORG/Conditions/HeartFailure/Heart-Failure_UCM_002019_SubHomePage.jsp 2. http://www.webmd.com/heart-disease/heart-failure/should-i-see-a-specialist-for-heart-failure 3. http://www.heart.org/HEARTORG/Conditions/HeartFailure/AboutHeartFailure/Classes-of-Heart-Failure_UCM_306328_Article.jsp#.Vvs9K-IrLIU 4. http://www.heart.org/HEARTORG/Conditions/HeartFailure/Recognizing-Advanced-Heart-Failure-and-Knowing-Your-Options_UCM_441926_Article.jsp#.Vvuy4eIrLIU 5. http://www.medicinenet.com/heart_failure/page4.htm 6. http://www.nytimes.com/ref/health/healthguide/esn-heart-failure-questions.html 7. http://www.everydayhealth.com/heart-health/congestive-heart-failure-life-expectancy.aspx 8. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/image/ucm_300674.pdf