Heart failure is an illness that cannot be completely cured. Treatment of patients and caregivers with heart failure provides some benefit in terms of improved survival over time. However, no benefit can be achieved until heart failure symptoms are eliminated and the underlying cause of the disease is treated. Current efforts toward treating heart failure cannot currently be seen as a cure.
In the United States there will be more than 1.4 million new cases of HF by 2030, leading to more than 40,000 HF related deaths.
There is ambiguity and confusion about definition, epidemiology, epidemiology, prevalence, symptomatology, pathophysiology, diagnostic testing and evaluation of HF. This confusion is further compounded by the prevalence of multiple subtypes of HF. This article tries to resolve some misconceptions and to highlight the limitations of using definitions defined by clinical observations rather than biomedical principles in defining HF. One definition is that HF is a syndrome involving signs and symptoms of a heart that is failing.
The primary treatment of heart failure is the optimization of heart failure symptoms and blood pressure, which can be aided by medications. Most individuals with severe disease will benefit from medications to control high blood pressure and to control heart valve issues. Newer medications are available, but current evidence suggests that they may not be as effective. The prognosis is not optimistic for a substantial number of individuals with heart failure. Many will develop the symptom of heart failure over a period of many years. The benefits of a device to pace the heart (cardiac resynchronization therapy) and medications for heart failure continue to be debated. Further evidence-based research is needed to determine if these therapies are effective and to identify those who will be most likely to benefit.
There are usually no signs of heart failure until left ventricular ejection fraction drops below 35 % and/or congestive heart failure develops. The signs of heart failure often are a manifestation of the underlying heart disease. Because of this overlap, no single sign or panel should be used for diagnosis of heart failure or as a screening criterion for symptomatic detection of heart failure. A cardiac catheterization should ideally be performed to rule out heart disease and assess for the severity of heart failure.
Achieving optimal medical management in HF patients has an effect on outcomes. This article highlights the need for a multidisciplinary approach to heart failure management in the elderly.
Exercise training and a regular diet have a significant positive effect on cardiac function or survival. Findings from a recent study shows that treatment has little or no effect on long-term improvement from exercise training in HF patients, which is supported by the results of other studies, while other trials have shown that pharmacological treatment with ACE inhibitors or angiotensin receptor blockers is beneficial in HF sufferers.
There has been a lot of work done to see if there is any improvement in the drugs and the treatments that are used for heart failure, so there is always new developments and new treatments being discovered on a regular basis. There is also the use of heart failure models - Animals and Human Heart Failure models have been developed and are gaining popularity. It is proving to be a practical way to identify new heart failure treatments, but more research will need to be done to determine which drugs will actually work in the real world.
The impact on the patient is considerable and can include a major change in lifestyle which may not be possible for younger patients. It is important, however, to emphasise that the primary role of treatment is to prevent further deterioration and to slow or halt the progression of disease.
Exercise-based lifestyle and medications may be effective in some of the patients with heart failure. We want to encourage them to participate in programs in their areas and take part in this treatment, so that they can regain the power of their hearts.
The treatments with beta blockers, ACE inhibitors and aldosterone antagonists should be evaluated in patients with heart failure who receive cardiac resynchronization therapy (CRT) and other treatment options should be tested, with more studies needed in order to clarify the optimal therapy for patients with heart failure.
While there were limitations with the study, this review highlights several limitations common to many clinical trials evaluating cardioprotective agents. Results from a recent paper of this trial should prompt researchers to evaluate in a larger study the efficacy and effectiveness of N-acetylcysteine in these patients.