Introduction
The development of heart failure (HF) is defined by blood not being pumped as actively as it should, causing the heart to malfunction. There may be additional conditions worsening the state of one’s heart, such as coronary artery disease or hypertension (Kurmani and Squire, 2017). As per Tiburcy et al. (2017), the problem with HF and every comorbid condition is that the inability of one’s heart to pump blood effectively might lead to serious injury or even death.
Most of the conditions associated with HF cannot be reversed, and clinicians focus on life-long sustaining repeated treatments to improve the patients’ quality of life (Metra, Dinatolo and Dasseni, 2019). For instance, Crespo-Leiro et al. (2018) suggest that the majority of HF cases could be prevented with the help of respective lifestyle changes and controlled comorbid conditions. The current paper aims to address the core issues associated with HF in the UK.
Aetiology of Heart Failure
A variety of diseases can lead to HF, and their timely detection can significantly improve patient outcomes. The first on the list is the presence of coronary artery disease (CAD), which is rather often accompanied by heart attacks (Wever-Pinzon et al., 2016). CAD should always be considered when testing a patient for HF because it is one of the most common causes that remains untested in many cases (Patel et al., 2017). The problem with CAD is that it reduces blood flow and increases the number of fatty deposits in a person’s arteries.
Additionally, all patients have to be tested for hypertension in order to help the practitioner ensure that all the extra exertions would not lead the heart muscle to become too weak or inflexible to respond to the blood-pumping task (Messerli, Rimoldi and Bangalore, 2017). In line with the evidence provided by Weitsman et al. (2017), it should also be concluded that faulty heart valves could have a detrimental effect on one’s blood flow and force the heart to work harder due to an unidentified issue (e.g., heart infection, defect, or CAD).
As for the less prevalent causes of HF, it may be safe to start with cardiomyopathy, which encompasses a number of heart muscle diseases, due to which the heart starts working less effectively (Rosenbaum, Agre and Pereira, 2020). When a person’s heart muscle is damaged, there may be numerous conditions contributing to it, which means that the toxic effects of illicit substances could give irreversible damage to one’s heart. Aragam et al. (2019) also claim that there may be genetic factors involved in this discussion. Another crucial condition to watch out for when preventing HF, according to Maisch and Alter (2018), is the process of heart muscle infection, also known as myocarditis.
When a person is born with a heart defect, it might also contribute to the advent of HF over time (Towbin and Jefferies, 2017). Harder blood pumping would also most likely lead to heart arrhythmias, causing much extra work for a patient’s heart. Thus, it is essential to assess the given patient for viruses when linking the discussion to a potential failure, as there are numerous infections that could generate a left-sided HF.
Prevalence of Heart Failure Statistics
One of the crucial venues allowing gaining more insight into the current statistics regarding the prevalence of HF across the UK is the report prepared by the British Heart Failure Society (2020), where it is directly mentioned that heart attack is one of the leading causes of HF. The country has at least 650,000 patients registered as being at increased risk of HF (British Heart Failure Society, 2020). The key problem pointed out in the report was that the majority of HF diagnoses were made in hospitals, with almost half of these cases being preventable in the case where the required assessment had been completed earlier (British Heart Failure Society, 2020).
With approximately 950,000 UK individuals living with HF, it becomes essential to touch upon this issue and deploy reports on heart-related conditions more often (British Heart Failure Society, 2020). The number of new diagnoses continues to increase, which exposes patients to an increased risk of other conditions, such as stroke.
The statistics also serve as a message to the UK health policy makers. There are at least 200,000 diagnoses per annum made by health care specialists across the UK that relate to heart failure (British Heart Failure Society, 2020). Knowing that the average age of patients with heart failure slightly exceeds 80, it should be claimed that the existing statistics could be perceived as a public service announcement motivating the government and healthcare organizations to join their forces and come up with better solutions intended to prevent a certain percentage of HF in the elderly (Testa et al., 2019).
Another crucial finding from the British Heart Failure Society (2020) was that the percentage of men suffering from HF significantly exceeds that same percentage of women, with females only leading the list of people affected by HF who are older than 85. Irrespective of the current initiatives discussed by the British Heart Failure Society (2020), the issue of heart failure across the UK remains rather consistent, with approximately 30% of all patients with heart failure being eligible for minimal exertion.
Also, it is mentioned in the report that the admissions linked to severe oedema were the most prevalent among all cases of HF (British Heart Failure Society, 2020). Current levels of community congestion make it a rather questionable health issue where the community should also exert a certain amount of effort in order to help healthcare providers find the right solution. Metra, Dinatolo and Dasseni (2019) shared their finding related to the idea that the length of one’s hospital stay might depend on their oedema as well.
Therefore, HF is an essential healthcare concept that has to be managed better if the UK-based hospitals expect to reduce admission percentage and the perceived length of stay among individuals with heart issues. British Heart Failure Society (2020) revealed that myocardial infarction and ischaemic heart disease were the most common predictors of HF in more than 60% of patients with heart issues. As noted above, such a high number urges the community and the government to take action.
Pathophysiology of Heart Failure
During the development of HF, systolic or diastolic function (or both) abnormalities cause the heart’s performance to worsen (Towbin and Jefferies, 2017). As a result, the heart is forced to pump more than usual, while delivering less oxygenated-blood to vital organs (Tiburcy et al., 2017). On the other hand, the changes occurring within the extracellular matrix might also transform the functioning of cardiomyocytes, exposing the given patient to an increased risk of becoming affected by heart failure. Weitsman et al. (2017) suggest that metabolic demands, structural defects, and an incredibly high heart rate can be perceived as the essential contributors to imminent heart failure.
In accordance with the evidence provided by Rosenbaum, Agre and Pereira (2018), it may be stated that the increased cardiac workload is generated by a poorly controlled state of hypertension, which means that the left ventricle could become hypertrophied rather quickly. On the other hand, hypertrophy is a compensatory mechanism that is aimed at the maintenance of cardiac output among patients with heart issues (Maisch and Alter, 2018).
When a person is affected by the long-term influence of such compensatory mechanisms, the cardiac filling becomes impaired, and the left ventricular output decreases significantly (Crespo-Leiro et al., 2018). Crespo-Leiro et al. (2018) also stated that appropriate guidance of patients with chronic HF also depends on the left ventricular ejection fraction, as this concept is directly related to phenotyping of heart failure as well.
In the left ventricular (LV) HF, the venous pressure grows and CO levels decrease. According to the Frank-Starling mechanism, the dysfunctions cause higher ventricular end-diastolic pressure, which then increases the volume of produced blood (Maisch and Alter, 2018). It serves to increase preload (the stretching of the muscle prior to contraction). However, when the pulmonary capillary pressure reaches a certain point, fluid fills the alveoli and causes pulmonary oedema and systemic congestion (Towbin and Jefferies, 2017).
Acute and Chronic Heart Failure
Acute HF is a condition that develops rather quickly and unexpectedly, leaving the patient exposed to severe health issues (Platz et al., 2017). One of the possible preceding events to HF can be a serious myocardial infarction that damages an individual’s heart and forces some of its areas to malfunction (Ponikowski et al., 2016).
On the other hand, Oliva et al. (2018) also suggest that such issues could be generated by chronic HF conditions causing the patient’s body to remain unable to respond to the acute pains generated by an acute HF. Despite the negative implications of acute heart failure, it is often followed by a quick recovery, lasting for a limited period of time (Halade, Kain and Ingle, 2018). The majority of treatments have to be administered intravenously in order to reduce the reaction time to medication and prevent further development of heart failure symptoms.
As for chronic HF, this condition is also rather common in patients with comorbidities, especially other cardiovascular problems (Collins et al., 2017). Compared to its acute counterpart, symptoms in chronic cases develop rather slowly, allowing for a gradual worsening and not an instant decline of one’s state of health. Mechler and Liantonio (2019) discuss the most tangible symptoms of chronic HF and outline the notion of acute decompensation.
It should be noted that episodes of acute decompensation should be avoided at all costs in order to minimize the number of patients with heart issues that have to be hospitalized (Dick and Epelman, 2016). When ventricles are not properly filled, it may cause the development of an irregular heart rhythm and further challenges associated with the heart’s wellbeing. Evidently, chronic HF has to be recurrently assessed by health care professionals in order to prevent patients from developing additional risk factors and exposing themselves to possible cases of acute HF.
Diastolic/Systolic Heart Failure Diagnosis
There are several essential tests that could help one to evaluate the patient’s health condition and predict the risk of HF. First of all, B-type or brain natriuretic peptide (BNP) test is the first-line diagnostic tool for HF diagnosis. It evaluates one’s cardiac functioning by measuring brain natriuretic peptide levels. This substance is produced in the ventricles and its causes the blood vessels to dilate (Francis, Felker and Tang, 2016).
BNP are designed to protect the heart from stress, but their high production leads to the heart not pumping enough blood to supply the tissue with oxygen. If the test shows low levels of BNP, then HF is usually ruled out, while high levels signify the lack of pumped blood and a HF diagnosis (Fu et al., 2018; Harvard Health, 2020). The higher the level of BNP is found in one’s blood, the worse their condition is (Harvard Health, 2020). Therefore, BNP testing should be the first test that practitioners use when suspecting HF.
While this test can reliably show HF, it may mislead a clinician if it presents mid-range peptide levels. On the one hand, milder cases of HF are more difficult to recognize, so these results should not lead to a full dismissal of the HF diagnosis (Harvard Health, 2020). On the other hand, in some conditions, such as atrial fibrillation, the levels of BNP are increased, which may lead to an incorrect diagnosis of HF (Felker et al., 2017). Thus, BNP testing should be approached carefully and should not be the only test in cases, where the patient has comorbidities or unusual symptoms. Without this knowledge, the practitioner might worsen a patient’s condition instead of improving it. In these situations, the following diagnostics can improve the diagnosis and pinpoint other underlying conditions.
Blood tests help the practitioner identify any signs of comorbid illnesses. Thus, the clinician can prescribe different medications or change the treatment strategy completely (Myhre et al., 2019). Another method discussed by Tripathy et al. (2019) is an electrocardiogram (ECG), which is utilized to evaluate the electrical activity within one’s heart and reach the verdict regarding the effectiveness of heart rhythm. Most often, ECGs are paired with ultrasound scanning (echocardiogram) in order to examine a patient’s heart with the help of sound waves as well. This test can show FH by determining the ejection fraction – the volume of blood that the LV pumps with each contraction; less than 55% ejection fraction rate increases the chance of HF diagnosis (Obokata et al., 2017).
One more test that is often overlooked is the breathing test. According to Sands et al. (2017), it could help find the reason for one’s breathlessness and identify lung issues if there are any. Often, practitioners tend to resort to chest X-rays when it is necessary to assess the size of one’s heart and check for fluid in the lungs, as the latter would signal that HF occurred previously (Sartini et al., 2017). These tests are necessary as they show the overall state of the patient and help identify exacerbating symptoms.
Conclusion
Heart failure becomes more significant for the contemporary community on a daily basis. The modern society is aging, which leads to an increased prevalence of conditions linked to one’s cardiovascular health. The pathophysiology of HF demonstrates that many risk factors predispose people to HF. The British Heart Failure Society’s report shows why the growing prevalence of heart failure has to be addressed with timely assessment and preventive treatment of underlying causes. Diagnostics such as BNP testing serve as the first-line assessment for HF diagnosis. Although it is costly, it provides a solid basis for urgent treatment. BNP allows practitioners to start managing the condition during its earlier stages. Some tests such as breathing tests, x-rays and ECG present an opportunity to prevent some cases of HF. Another area of research that would have to be addressed further is the quality of life in patients who suffer from both chronic and acute heart failure cases.
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