Heart Failure Epidemiology in the UK

Introduction:

According to the American Heart Association, Heart Failure [HF] is referred as a complex clinical disorder in which the heart is unable to maintain proper circulation into the natural body, due it functional and structural impairment. Recent studies have shown that Heart Failure is the chronic heart condition in which heart is unable to pump sufficient blood into a different part of the body in order to regulate overall functions of the body [WHO, 2019]. National Institute of Care and Excellence [NICE] database shows that more than 900,000 people across the UK suffer from heart failure due to the changing demographic condition with the majority of the people are aged. [NICE, 2010]. Majority of the people, having cardiovascular disease and myocadiac infarction are highly prevalent to heart failure. Heart Failure is considered by health professionals as one of the major epidemics that is associated with several health problems such as lung failure, breathing issues and poor brain functions (Holden et al. 2015). The epidemiological study of Heart Failure shows that this is major health issues which have a prevalence of 23 million people across the world [www.ncbi.nlm.nih.gov, 2019]. The Epidemiological Study of Heart Failure in the UK shows that nearly 4% general population in the UK is affected by heart failure, which increases steeply with the evidence of cardiac syndrome [medicinejournal.co.uk, 2019]. As compared to men in the UK, women are 25% more prevalent to Heart Failure due to their poor health, irregular eating, poor eating habits and lack of healthcare and social support.

Aetiology of Heart failure:

The case or aetiology of Heart failure is multifactorial aspects (Pieske et al. 2017). The common causes of heart failure are hypertension, cardiovascular disease, coronary arterial disease, arterial damage, cardiomyopathy, infection on cardiac valves and myocarditis. Based on the recent database and researcher following are the most common risk factors of heart failure:

Coronary Arterial Disease (CAD):

Based on the recent report of American Heart Association, several epidemiological studies show that there are several risk factors associated with the occurrence of heart failures such as Coronary Arterial Disease, hypertension, vascular heart disease, metabolic syndrome and diabetes [WHO, 2019]. Data from National Institute of Care and Excellence [NICE} shows that the prevalence of heart failure is less than 2% in the age group of 23-39 years, and more than 25% at the age of above 80 years [www.ncbi.nlm.nih.gov, 2019]. Based on the database of World Health Organisation, Coronary Arterial Disease is mainly occurred in aged people due to poor pumping ability if heart, which enhances the chances of heart failure in case of the aged people.

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Faulty Heart Valves:

Valves of the heart are the important part which assists the blood to flow in the proper direction (Platz et al. 2016). Damaged valves due to heart infection, inflammation on heart ventricle, hypertension and damaged arteries makes it difficult for direct blood into a proper way. World Health Organisation states that damaged valves of the heart cause wrong flow of oxygenated and carbon dioxide blood, which leads to improper blood circulation thereby causing several health issues such as breathing issues, heart failure, lack of brain functions and poor muscles activity [WHO, 2019].

Myocarditis:

Database from the American Heart Association, Myocarditis is chronic inflammation of heart muscles, which is associated with poor contraction and expansion during the heart pumping process (Freedland et al. 2015). This leads to a lack of ability of heart in order to supply proper blood to the entire body.

Cardiomyopathy:

Cardiomyopathy is considered as one of the important reasons behind occurring heart failure. In this condition, the heart has damaged cardiac muscles (Pandey et al. 2015). Due to damaged cardiac muscles, the heart is unable to pump proper blood into the circulation, thereby leading to poor brain functions and lack of major activities of the body. This condition occurs due to alcohol abuse, disease, infections and inflammation of cardiac arteries.

Hypertension:

American Heart Association states that Hypertension is associated with high blood pressure, which causes permanent damages od arteries thereby making the arteries unable to maintain proper blood flow into circulation [AHA, 2019]. This condition is known as Hypertensive Heart Failure [HHF]. According to Pieske et al. (2017), hypertension brings on heart failure through causing the left ventricle hypertrophy, the thickening of heart muscles resulting in less effective muscle relaxation during the heartbeat.

Other cause:

There are other causes of heart failure such as myocarditis, arterial infections, endocarditis, pericarditis, diabetes and alcoholism,

Symptoms:

Different symptoms and signs are associated with heart failure which is as follows:

Dyspnoea is one of the common outcomes of heart failure, in which patients are unable to take sufficient oxygen through the lungs in order to meet their body's oxygen need (Køber et al. 2016). Based on the database from the world health organisation, this condition occurs due to the overload of pulmonary circulation. This condition is known as Chronic Obstructive Pulmonary Disorders (COPD), accumulation high amount of fluid into pulmonary circulation makes it difficult for the blood vessel to supply the proper amount of oxygen to the blood. Therefore, the brain is unable to get proper oxygen. In most of the case of heart failure patient needs the ventilation support due to the inability of the lung to take oxygen from the air.

Impaired cardiac output is one of the major symptoms of HF, in which due to overfilling of the vascular system, the increased capillary pressure occurs (Desai et al. 2015). Due to the pulmonary capillary filtration pressure is increased, it leads to increase of capillary osmotic pressure. In this situation, the intravascular fluid enters into a lung that leads to pulmonary oedema.

Fatigue is one of the common symptoms of Heart Failure, in which patients suffers from the increased fluid volume in the lungs and body tissues and decreased cardiac outputs.

Reduction of skeletal muscles perfusion is one of the common symptoms of heart failure which is occurred due to cardiac failure (Køber et al. 2016). The patient sometimes may be tachycardiac due to the increasing rate of muscles contraction and decreased cardiac outputs.

Investigation and Diagnosis:

Based on the database of the American Heart Society, Heart Failure is a chronic condition, which is characterised by hypertension, fatigue, dyspnoea, peripheral oedema. Recent research and investigation on the diagnosis of heart failure state that, proper diagnosis of this disease is based on physical and historical examination of patient's heart (Desai et al. 2015). According to the World Health Organisation database, the initial evaluation in determining heart failure is associated with chest radiography, laboratory assessment, electrocardiography, findings of interstitial oedema and venous congestion. Through conducting laboratory assessment, health professionals determine the causes and precipitating factors associated with heart disorders. According to (), Systolic heart failure occurs due to Framingham Criteria are not met, which leads lower of B-type natriuretic peptide.

Echocardiogram:

Echocardiography is one of eth important diagnosis process for detecting ischemic heart disease (Køber et al. 2016). This process assists doctors to use the sound waves in order to record the motion and structure of the heart. Through this process, it is possible for the health professionals to determine whether the patient has heart failure, especially if the patient has angina. Moreover, through this process, the health professional can evaluate the heart condition in order to determine whether there is any case of Coronary Arterial Disease or hypertension.

Based on the database of the American Heart Association, there is no single diagnosis process for detecting heart failure. The overall investigation of heart failure is associated with conducting systolic and diastolic diagnosis therapy, which assist health professionals to determine the heart condition. Recent survey on Heart condition in the UK by World Health Organisation shows that, by conducting proper diagnoses such as Echocardiography, chest radiography and laboratory assessment, doctors are able to recover the heart condition of 89% patient in one month, 79% in one year and only 58% in one year (WHO, 2019).

Chest radiography:

Recent evidence shows that, by using chest radiography and determining the frequency of Displaced Cardiac Apex, the third heart sound, doctors are able to find out the pulmonary venous congestion and interstitial oedema. According to Zannad et al. (2015), both the pulmonary venous congestion and the interstitial oedema are a good predictor of a poor heart condition as well as heart failure.

Cardiac catheterization:

Cardiac catheterization is processed, through which doctors are able to determine any type of abnormalities and damages in coronary arteries (Givertz et al. 2015). In this process, health professionals insert a small tube into blood vessels and pull it from the upper thigh, wrist and arm. During this movement, doctors can take the X-Ray to view coronary arterial, check the blood pressure and blood flow in heart chambers.

MRI:

Through conducting an MRI, doctors are able to take pictures of the inner side of the heart. this process enables doctors to determine any types of damages within the heart.

Blood test:

Blood test assists health professionals to determine any type of blood cell abnormalities and infections (Freedland et al. 2015.). Moreover, doctors can check the level of BNP, the hormone which increases due to high blood pressure and heart failure.

Determining the level of B type natriuretic peptide:

Systolic heart failure is effectively determined through evaluating the level of B type natriuretic peptide and the N-terminal pro–B-type natriuretic peptide [WHO, 2019]. As stated by Pandey et al. (2015), through determining this level, health professionals can evaluate the current heart condition of the patient. If there is a low level of B type peptide then it points out to the fact that Framingham Criteria are not met properly, which proves that patient has systolic heart failure condition.

Treatment process:

Several medications are used in the treatment of heart failure which is as follows:

ACE inhibitors:

Angiotensin Converting Enzyme inhibitors (ACE inhibitors) work on the narrow blood vessels and open it up in order to improve the blood flow. As stated by Givertz et al. (2015), in some patients with heart failure ACE inhibitors cannot be tolerated by patient’s body. In that case, doctors prescribe Vasodilator for improving the blood flow. Following medicines are generally prescribed by doctors in heart failure as ACE inhibitors

Lotensin (Benazepril)

Capoten (Captopril)

Vasotec (Enalapril)

Monopril (Fosinopril)

Zestril (Lisinopril)

Beta Blockers:

Beta-blocker is used to reduce blood pressure and slow down the faster heart rhythm.

The prescribed Beta Blockers are:

Sectral (Acebutolol)

Tenormin (Atenolol)

Zebeta (Bisoprolol)

Cartrol (Carteolol)

Brevibloc (esmolol)

Lopressor (metoprolol)

Diuretics:

Diuretics reduce the overall fluid content of the body (Freedland et al. 2015). HF leads to increase of body fluid that the body actually needs, which pose extra pressure on the arteries and vessels of the heart.

Doctors recommend

Thiazide diuretics: it widens the blood vessels and assists the body to remove the extra fluids. This includes Zaroxolyn, Microzide and Lozol.

Loop diuretics: These medicines assist kidney to produce a high amount of urine in order to reduce the extra fluid from the body. This includes Edecrin, Lasix and Demadex.

Surgeries:

In most of the cases, of heart failure medicine is not effective for treating heart failure. In these cases, the most invasive procedure is required for making an immediate recovery (Holden et al. 2015). Angioplasty is one of the important procedures in which doctors open up blocked arteries by surgery. Through angioplasty, cardiologists also repair the damaged cardiac valves in order to help the valves to close and open in a proper manner for maintaining proper blood flow into circulation.

Psychological and social effects of HF:

Psychological effects:

Psychological issues are the important variables in case of patients with heart failure. Database from World Health Organisation (WHO) shows that, in most of the cases of HF, the psychological issues are overlooked, which enhances the rates of mortality and morbidity in society [WHO, 2019]. As stated by Desai et al. (2015), common psychological effects of Heart allure are depression, anxiety, negative thoughts, poor brain functions, lack of problem-solving skill, poor decision-making ability and low self-confidence. Recent studies have shown that patient with heart failure are always tensed and depressed. Due to abnormalities in heart rhythm, blood viscosity and blood pressure, the patient suffers from a high level of emotional stress, that affects directly on their memories and brain functioning. As stead by (), patient with heart failure is highly prevalent to hallucination, dementia and short time memory loss. Moreover, hear failure leads to the development of negative and poor thoughts into the mind, which lowers self-confidence of people. based on the database of National Health Service (NHS), the majority of cases in heart failure patients often prefers to stay alone and they do not share their issues with anyone. According to the American Heart Association (AHA), through conducting effective psychotherapies it is possible to improve mental strength and memories of the patient suffering from heart disease. through regular counselling, it is also possible to improve the psychological stability in patients.

Social effects:

As stated by Pieske et al. (2017), social effects of heart failure are associated with discrimination, abuse and bias in the community which not only damages the psychological strength of people but also leads them towards mortality and morbidity. Database from the World Health Organisation, a survey on Heart failure shows that the majority of the patient with heart failure is treated as a burden in their family [NHS, 2019]. In most of the cases, there are discriminated and abused in society due to their poor contribution in any social activities. In some cases of heart failure, family members feel it highly embarrassing to take the patient on any occasions. Lack of social support is one of the major outcomes of heart failure which affects the brain functions, emotions, and psychology of the patient. UK government has conducted an awareness campaign in society in order to enhance awareness in society about heart failure and its adverse impact on patients.

Conclusion:

From the above-mentioned study, it can be concluded that heart failure is a chronic condition, in which the heart is unable to pump blood into circulation. Heart failure has several causes such as hypertension, coronary arterial disease, damages in cardiac muscles and myocardiopathy. Diagnosis of heart failure is the multidimensional process which includes MRI, blood tests, chest radiography and echocardiogram. Hear failure has a potential impact of psychological and social factors, which not only damages the mental ability of patient but also expose them towards a high rate of mortality and morbidity. Through conducting proper counselling and psychotherapies it is possible to improve the overall mental health of patient suffering from heart failure.

Reference list:

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Freedland, K.E., Carney, R.M., Rich, M.W., Steinmeyer, B.C. and Rubin, E.H., 2015. Cognitive behavior therapy for depression and self-care in heart failure patients: a randomized clinical trial. JAMA internal medicine, 175(11), pp.1773-1782.

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