Congestive Heart Failure (CHF)

Congesitve heart failure (CHF) is a condition in which the heart cannot pump an adequate supply of blood to meet the metabolic needs of the body. It is usually the result of long-term progressive heart disease. An estimated 4.6 million Americans have CHF. The prevalence of heart failure increases with age; about 10% of people age 75 and older have heart failure (see bar graph below)

CHF is the most common reason for hospitalization in patients over 65 years of age. About half of all persons with overt heart failure die within 4 to 5 years after onset of this condition. Death occurs suddenly in nearly one-half of heart failure patients due to ventricular arrythmias.

Many elderly are unaware they have heart failure although they experience symptoms such as shortness of breath or edema in their lower extremities. Instead they restrict their daily activities and stay relatively asymptomatic until the disease progresses to a more severe level and is finally diagnosed. The advanced stage of CHF often makes controlling symptoms and managing the disease in older adults more difficult.

Management of CHF

The primary goal of treatment is to control symptoms, improve physical functional, and prevent progression of the heart disease. One of the most important interventions is dietary-- restriction of fluids and sodium intake. Medications are used to help the heart pump more efficiently. They generally include:

• ACE (Angiotensin-Converting Enzyme) Inhibitors (e.g., Vasotec, Prinivil, Zestril, Capoten) are also used to treat high blood pressure. They have become the mainstay treatment for congestive heart failure and are the only drugs that have been clearly proven to help people with the disease feel better and live longer. ACE inhibitors allow blood to flow from your heart more easily by decreasing production of a hormone (angiotensin II) that constricts your arteries and raises your blood pressure. They also decrease production of the hormone (aldosterone) that causes your body to retain sodium and water. About 20 percent of people taking ACE inhibitors experience an irritating cough.
• Diuretics or "water pills" (e.g., Lasix) act on the kidneys and cause you to urinate more frequently. They decrease fluid in your lungs so that breathing is easier and prevent retention of excess fluid which can overload the heart..
• Inotropics (e.g. digitalis) increase the stength of heart contractions and thereby improves the pumping action. A recent NIH study showed that while digoxin doesn't improve overall survival rates, it does improve symptoms and the ability to function with the condition. Older adults must be monitored closely for the signs and symptoms of digitalis toxicity which include: fatigue, anorexia, nausia, generalized msucle weakness, yellow-green halos around visual images, blurred vision, and arrhythmias.
• Beta Blockers (e.g., Inderal) may improve blood flow and help prevent some heart rhythm problems. A new drug, carvedilol (CoregŠ), received Food and Drug Administration (FDA) approval in May 1999.
  
  

• weight gain of 3 to 4 pounds within 1 to 2 days
• persistent cough or shortness of breath
• swelling of feet or hands.