Monday, January 22, 2018
Health

A heart failure crisis

TAMPA

If current health trends continue, 8 million Americans will suffer from heart failure by 2030. • Treating them will cost $70 billion, according to the American Heart Association, more than double the cost for such patients last year. • That comes out to $244 a year for every American taxpayer to pay costs associated with hearts so weak, they can no longer pump enough blood to meet the body's need for oxygen and nutrients.

Dr. Gus Agocha, a heart failure specialist at St. Joseph's Hospital in Tampa, believes those startling estimates may be a little low.

"People of all ages and all backgrounds develop heart failure," Agocha said. "It's the common result of many conditions related to heart disease. All of these conspire to weaken the heart."

Blame this trend on an aging population with high rates of obesity, diabetes and heart disease.

But the news isn't all bad. There are a lot of things you can do to prevent heart failure. And even if you have been diagnosed, you can take action to improve your health or at least slow progression of the disease.

• • •

While most patients are diagnosed after age 65, heart failure is not an inevitable part of aging. Most contributing factors are preventable or at least controllable, including smoking, excessive use of alcohol and undiagnosed or poorly controlled high blood pressure, obesity, high cholesterol and diabetes. Having multiple heart attacks, faulty heart valves or an abnormal heart rhythm also puts you at risk.

And despite its name, the condition is not always hopeless.

"Heart failure is an unfortunate name for the condition," said Agocha, who is medical director of the recently renamed Heart Function Clinic at St. Joseph's Hospital. "No one knows what (heart failure) means. But people do understand when you tell them the reason they feel bad is because their heart isn't functioning well."

At 68, Raul Cabrera had a long history of high blood pressure, diabetes and high cholesterol. He's also had two heart attacks, several bypass surgeries and stents placed to hold open blocked vessels. Two years ago, he had a defibrillator put in his chest to control potentially fatal irregular heartbeats.

He had to give up his career as a professional dancer. "My wife and I were known as the Boppers. We danced on cruise ships and with big bands, mostly '50s rock 'n' roll. I just didn't have the stamina to do it any more," he said.

Cabrera's legs and abdomen were so swollen from fluid retention due to his illness, "I looked like I was having twins," he said. "I thought I was a goner."

Last year, he became a patient in the Heart Function Clinic. There, Agocha's team addresses each problem— from abnormal heart rhythms, leaky valves and chest pain to kidney problems, high blood pressure, cholesterol, diabetes, lifestyle and diet issues—in one clinic setting, usually in one appointment.

A year ago, Cabrera had a shopping bag full of medications from several different doctors. Now, he takes just five, all prescribed and managed by Agocha. Two weeks ago, Cabrera returned to the dance floor with his wife of 38 years.

His physician applauds that development, especially since one of the best treatments for heart failure is exercise.

"It reduces symptoms, improves quality of life and reduces hospitalizations," Agocha said.

St. Joseph's has an exercise and rehab program specially designed for heart failure patients; Cabrera went through the program and continues to attend rehab three times a week at the hospital.

• • •

Some patients improve to almost completely normal heart function and lab numbers, depending on the cause and extent of their heart failure. Others, especially those with previous heart attacks, have sustained permanent damage to the heart muscle and may need a heart transplant.

As with so many health conditions, the best way to deal with this one is to ''prevent the conditions that lead to heart failure," Agocha said.

No. 1 on his list is high blood pressure, which affects about 75 percent of heart failure patients. It can go undiagnosed for years, causing damage silently until you have a stroke or heart attack.

But it's difficult to get patients to change their lifestyles or take medication for a condition that doesn't make them feel sick. Many people stop taking blood pressure medication because of the side effects.

"If someone tells you, 'you have heart failure,' you have to ask why, and what's the cause? And treat those problems," said Agocha, "That's where the focus should be."

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