Understanding that sodium is salt may help them better
read food labels and maintain a low sodium diet.
Patients should ask their providers about anything
they are the least bit unclear about, even asking the same
question more than once if needed. It is a good idea to keep a
notebook or tablet handy to keep track of questions to ask the
healthcare team during the next day’s rounds, as well as to
record the physician’s answers.
QUALITY OF LIFE
Grady points out that HF adversely affects quality of
life and the worse the condition, the greater the effect.
Shortness of breath, fatigue and depression all impact HF
patients. They may be unable to walk across the room or
may need to sleep in a semi-reclining position because of
fluid retention. “They are often, as it gets worse, unable
to work and have frequent re-hospitalizations, which also
affects their quality of life,” Grady said. They may be
socially isolated, because they just don’t feel good and
can’t do the things they usually do with friends.
Family caregivers may be called upon to provide
“The ultimate goal of promoting HF self-care is to
myriad tasks — filling pillboxes, ferrying patients to
appointments — as well as providing emotional support.
What is true for patients is true for caregivers: the worse
the HF, the greater the caregiver’s burden, which may
affect their quality of life. It can be especially difficult if
the caregiver is the spouse and of a similar age, because
they may have their own health problems. “It can be a
real challenge for them to be the caregiver,” Grady said.
“But despite the burden, some of them find there are
positives that bring them closer together as they deal with
While there are clearly positives, it’s a condition that
does, eventually, have a terminal course. Some patients
with advanced HF may be candidates for surgical
interventions, like heart transplantation or mechanical
circulatory support. “Patients who undergo these therapies
and do well can improve not only their length of life, but
also their quality of life,” Grady said.
reduce the frequency of HF hospitalizations and enhance
patient outcomes, including both survival and quality of
life,” Grady said.
ike O’Meara of Philadelphia thought his heart
failure was under control after he had an
implantable cardioverter defibrillator/pacemaker
placed in October 2011. Despite developing high blood
pressure in his 20s, diabetes in his 40s and having a stroke
in 2009 at age 62, he considered himself healthy — after
all, he had recovered completely from the stroke and was
playing golf every day and working full time. “I didn’t care
what my diet looked like,” he said. “If it was cold, I drank it,
and if it was hot, I cut it up and ate it.”
But his good health was an illusion because his ejection
fraction was declining. By January 2014, it was 15 percent.
(Ejection fraction is a measurement of how much blood the
left ventricle pumps out with each contraction. A normal
ejection fraction is between 50 and 70 percent.)
While attending a fundraising event with his wife
Beth, who works in cancer research, he developed
flu-like symptoms. They left the gathering early, with
Mike going in and out of consciousness as Beth drove
home. “I monitored Mike through the night, and in the
morning, we put him in the car and I drove to the Hospital
of the University of Pennsylvania,” Beth said. Mike was
already known to the cardiology/pulmonary team there
as he was being evaluated for ischemic cardiomyopathy
and pulmonary hypertension. The next day a right
catheterization showed a blockage in his coronary artery;
1 in 5 Americans will
develop heart failure