Nov 26 – Heart failure was an incurable heart disease in the past. As the heart gradually weakened, the patient would gradually die.

Heart failure refers to a disease in which the heart gradually becomes weaker. Its true definition is that the heart muscle gradually weakens, resulting in the heart being unable to supply enough blood to the body’s organs, thus endangering life.

For many Malaysians, heart failure is not a familiar heart disease. Many people know about cardiovascular blockage and sudden heart attack, but very few know about heart failure, not to mention the serious situation that 6 to 10% of people are hospitalized due to heart failure every year.

National Heart Center
Heart failure care team

With the substantial increase in various chronic diseases among Malaysians, including high blood pressure, diabetes, high cholesterol, etc., which are chronic diseases that lead to heart disease, the incidence of heart failure is increasing, but only 1 in 10 people can identify as having heart failure.

Symptoms of heart failure include severe breathing difficulties, ankle swelling, rapid weight gain and difficulty in moving, such as climbing stairs. Data shows that 76% of patients with heart failure find daily activities difficult and inconvenient.

Promote heart failure awareness campaign

In order to raise awareness of heart failure among patients and the public, the National Heart Center and Novartis Group launched a heart failure awareness campaign called “Keep it Pumping”, hoping to raise public awareness of heart failure, including educating people about the symptoms, incidence and severity of heart failure, while also helping patients cope with the disease.

The event was attended by Dr. Zhou Shunping, senior consultant cardiologist at the National Heart Center, Dato’ Aizam Abdul Rahim, head of the cardiology department, and Susan Gruber, head of franchise operations at Novartis Group (Malaysia). The company also introduced its new heart failure drug ENTRESTO (LCZ696) at the event.

Zhou Shunping said that after understanding the challenges faced by heart failure patients, the center has implemented a heart failure patient care program, which consists of a team of cardiologists and professional nurses to take care of heart failure patients. The team will also cooperate with other departments to help reduce the number of patients’ hospital stays and unplanned re-hospitalizations, and improve their quality of life.

He said that studies have shown that disease management programs can reduce the chances of readmission for patients with heart failure and cardiovascular disease by up to 30%, which means that as long as the disease can be well managed, the patient can reduce the chance of hospitalization.

Will relapse continuously, with a survival rate of up to 5 years

He said: “The survival rate of people diagnosed with heart failure is at most 5 years, and some even have less than 1 year. Based on the average population prevalence of 1%, there are currently about 300,000 heart failure patients in the country. According to statistics from the National Heart Center, about 10-20% of patients are hospitalized regularly because the disease will recur continuously, causing patients to have difficulty breathing and need to be hospitalized.”

Complications caused by other diseases

Heart failure is not a single disease, it is a complication of other diseases, including cardiovascular disease, high blood pressure, cardiomyopathy (weak heart) and valvular heart disease (valve failure to work properly, affecting heart function).

Therefore, when treating patients, the cause of the disease will be found first before the right medicine can be prescribed. For example, cardiomyopathy and valvular disease have different treatments, although they both cause heart failure. Controlling and relieving symptoms is the key to treating heart failure, thereby reducing the chance of hospitalization and increasing survival rates.

When medications fail to control the condition, surgery is necessary

However, Zhou Shunping also admitted that heart failure cannot be cured. All doctors can do is to find out the cause of the disease and prescribe medicine. When medicine cannot control the disease, it is necessary to implant devices or perform surgery in the body, such as artificial valves, artificial hearts, or even heart transplants.

Although there is a limit to what doctors can do, they advise patients to manage their condition, including understanding their own condition and adjusting their lifestyle, such as eating a low-fat, low-salt diet and reducing strenuous activities. Most importantly, they should obey the doctor’s orders and take their medicines on time, rather than stop taking the medicines on their own when they think they are better, which will eventually require them to go back to the hospital.

Develop a management plan for the patient

He said that the number of patients admitted to the National Heart Center due to heart failure has increased year by year, doubling from 363 in 2009 to 961 last year. For this reason, the center opened a heart failure clinic in 2014 to specialize in the care of heart failure patients, and has a dedicated nursing team to take care of the patients.

“In addition to clinical care, nursing staff also act as nutritionists, physiotherapists and pharmacists to provide patients with consultation on all aspects, including diet, exercise, rehabilitation, medication, etc., and formulate management plans for patients to avoid patients being readmitted to the hospital due to poor care after discharge.”

Before a cure is found, pharmaceutical companies will continue to develop new drugs and allow hospitals to participate in new treatment trials. Zhou Shunping also said that the National Heart Center does allow some patients to undergo new drug trials, and patients may respond to these experimental therapies, but all new drugs require time to verify and track the patient’s condition, so the effect cannot be seen in the short term.

Key Challenges in Heart Failure

• One million people in Europe and the United States are hospitalized for heart failure each year, accounting for 1-4% of hospitalizations.
• The average length of hospital stay is 5 to 10 days
• 1 in 4 patients discharged from hospital will be hospitalized again within 30 days
• About 46% of patients were readmitted to the hospital within 60 days of discharge, and 40% of patients died after 1 year.

Heart failure symptoms

• Difficulty breathing
• Fluid accumulation causing swelling in the limbs
• Severe fatigue
• Cough/wheezing
• Nausea
• Edema and weight gain
• In severe cases, I cannot fall asleep at night and need to use several pillows to prop myself up.

Do you have heart failure?

Left heart failure

• Insufficient blood output: dizziness, less urination, cold hands and feet, palpitations during exercise
• Intracardiac pressure increases: coughing in the middle of the night, unable to lie down

Right heart failure

• Swelling of feet, swollen eyelids, abdominal distension, and distended carotid arteries

Controlling blood pressure
reduces the risk of heart failure by half

Datuk Aizawl Abdul Rahim, Head of the Cardiology Department at the National Heart Centre and Consultant Cardiologist, said that in addition to seriously affecting the quality of life of patients, heart failure also places a heavy burden on the patients’ families because they do not have sufficient knowledge about heart failure and do not know how to prevent it. Many people do not even know that the mortality rate of heart failure exceeds that of some cancers.

“Especially in Malaysia where cardiovascular disease is high, this may lead to more heart failure patients. Worryingly, more than half of patients hospitalised for heart failure will die within six years,” he said.

The number of people with three highs and one obesity in Malaysia continues to rise

Heart failure is one of the diseases suffered by the elderly. As the problem of population aging becomes more and more serious, more and more people will suffer from heart failure. The Malaysian Health Survey Report published every five years shows that the number of people with “three highs and one obesity” remains high, which indirectly leads to the continuous increase in the number of people suffering from heart disease in our country.

Ai Zai said that although the number of deaths from heart disease has decreased due to medical advances, more people have their hearts damaged by various heart diseases, resulting in many sequelae.

He said that although nearly 1,000 new heart failure drugs have been developed in the past 20 years, only 20 have been approved for use. However, it is undeniable that some new drugs have indeed improved patients’ survival rates.

According to the Asian Heart Failure Sudden Death Rate Statistics Report, sudden death rates due to high blood pressure and cardiovascular diseases account for two-thirds of the causes of death in Malaysia. Among the three major causes of heart failure, in addition to high blood pressure and cardiovascular diseases, heart valves are the third major cause.

Therefore, he reminded patients with hypertension that if they can control their blood pressure well, the chance of developing heart failure will be halved.

New drug could reduce cardiovascular disease mortality by 20%

On the other hand, Ai Zaiya mentioned the LCZ696 heart failure new drug trial, which involved 47 countries, including Malaysia. The results showed that LCZ696 can reduce the risk of cardiovascular disease mortality by 20%, reduce hospitalization rate by 21%, and reduce the risk of all mortality by 16%.

“Overall, the new drugs are helping to reduce the incidence of heart failure, and could reduce cardiovascular mortality by 20 percent or delay the time to hospitalization for a first heart failure episode.”

In addition, Susan Gruber said that 26 countries around the world have approved the use of LCZ696, and Malaysia approved its use this year. Currently, about 100 Malaysian patients are taking it, which is a first-level drug.