Heart failure affects almost 6 million people in the United States. Half will die within five years of diagnosis, according to the Centers for Disease Control and Prevention (CDC). Failing to make lifestyle changes or take prescribed medications can contribute to worsening symptoms and raises the risk of hospitalization. However, less than 10 per cent of those affected will follow their doctor’s recommendations to improve the condition, according to a new study. The researchers found being lonely may be the biggest reason why.
“We suspected that adherence to lifestyle recommendations would be low, but we didn’t think we’d find that only seven percent of patients followed all of them,” Natalia Świątoniowska, a study author and researcher in the department of clinical nursing at Wroclaw Medical University in Poland, told Healthline.
The study was presented at the annual meeting of the European Society of Cardiology in late May.
The findings haven’t been published yet in a peer-reviewed journal.
According to the study, the four lifestyle changes involve:
- monitoring weight changes
- reducing salt intake
- reducing fluid intake
- exercising more
Researchers defined following the recommendations as “every day” or “three times a week” for checking their weight and “most of the time” or “all the time” for salt, fluid, and exercise.
“The least followed advice was to increase physical activity and reduce salt and fluids,” said Świątoniowska. “This was surprising because you’d think that limiting liquids or salt would be easy for patients or their caregivers to follow.”
Why recommendations are vital
Dr. Victoria Shin, a cardiologist with Torrance Memorial Medical Center in California, explained that a symptom of heart failure is excess fluid retention and limiting liquids can address that issue.
Daily weighing is also important because if you’re retaining fluid “one of the manifestations of this is weight gain that’s noticeable over one or two days,” Shin told Healthline. “This can happen before other heart failure symptoms such as shortness of breath or swelling show.”
She explained that the advice to reduce salt intake comes with a caveat.
“Dietary salt intake retains fluid further, worsening the problem,” Shin said. “We often instruct heart failure patients to restrict their daily sodium intake to less than 2,000 mg per day. But, a review of the scientific literature finds no rigorous evidence-based data suggesting salt restriction in heart failure patients is absolutely necessary.”
Heart failure can be managed
Dr. Robert Segal, the founder of Manhattan Cardiology in New York, said people with heart failure can have active lives.
“Heart failure simply means that the heart is not pumping enough blood, so the body isn’t getting enough oxygen,” Segal told Healthline. “While this is a serious condition, it doesn’t mean that people living with heart failure cannot live a full life. It can be managed.”
“Overall, the prognosis for heart failure has improved significantly over the years with more and more proven therapies,” added Shin.
But she cautioned that sometimes the damage is such that the heart muscle is scarred. In that case, recovery may be partial or not at all.
“But this also depends on the cause,” said Shin. “If it’s due to substance abuse, stopping that and using the prescribed medications can often help the heart muscle recover. If atherosclerosis is to blame, and the blocked arteries can be fixed, then the heart muscle can recover as well.”
Segal added that other causes include diseases such as severe lung disease, diabetes, obesity, and sleep apnea.
“People who are afflicted with those diseases will likely develop heart failure if it’s not addressed immediately,” he said.
Symptoms of heart failure
According to Shin, symptoms of heart failure include fatigue, shortness of breath when active, difficulty breathing while lying down, and waking up in the middle of the night due to shortness of breath.
People experiencing heart failure can also have swollen legs, rapid weight gain over a couple of days (from fluid retention), and a persistent cough.
The American Heart Association cautions that while any one symptom of heart failure may not be a reason to worry, having more than one symptom means you should contact your healthcare provider and ask for a heart evaluation. This is important even if you haven’t been diagnosed with any heart problems.
Segal said risk factors for heart failure include the traditional ones for heart disease, including high blood pressure, high cholesterol, diabetes, obesity, smoking, alcohol abuse, and drug abuse.
But risk can include things more difficult to avoid, like “family history of cardiac muscle problems, cardiotoxic chemotherapy agents, and, unusually, sometimes viral illnesses can attack heart muscle to cause heart failure.”
The need to be vigilant
Świątoniowska said the study findings indicate a need for special interventions to address the problem of patients’ poor adherence to recommendations in long-term treatment.
“Healthcare professionals should identify strategies for increasing adherence to recommendations in their daily practice,” she said.
There is also a close relationship between social support and health.
Świątoniowska pointed out that previous studies have found social isolation has a negative effect on heart failure patients. It adversely affected making medical appointments, taking medicines, and making lifestyle changes.
“Family members play a crucial role because this is where patients can get guidance and support,” he said. “Especially for elderly patients, it’s normal to forget their medications and feel that they don’t need it. It’s up to family members to follow up and make sure that the right medications are taken on time as well as ensure proper diet or exercise advice is also followed.”
The bottom line
A recent study finds less than 10 percent of heart failure patients follow doctors’ recommendations for important lifestyle changes.
Researchers say the findings suggest loneliness is a big factor preventing adherence to these recommendations.
While heart failure is a serious condition, the prognosis is good if patients take prescribed medication and follow the advice of a healthcare provider.
Experts agree a solution is for both doctors and caregivers to be more vigilant in ensuring that heart failure patients do everything necessary to successfully manage their condition.