Every minute in this country, two people are hospitalized for heart failure.
Blacks are at a much higher risk and are affected at an earlier age by the condition more than any other race.
Michele N., 63, leads a busy life as a business manager, a recovery support group leader, and an active member of her church.
In 2016, she started experiencing swelling in her legs and shortness of breath. She went to a physician for what she thought were allergies and asthma.
But the symptoms worsened, and soon Michele wasn’t able to walk to her car after work without help from a coworker or taking breaks.
Her physician referred her to a cardiologist, and, after an echocardiogram, Michele was diagnosed with a chronic type of heart failure.
Having lost her mother 12 years earlier to heart failure, she was terrified to hear her diagnosis.
But Michele’s cardiologist prescribed medication for heart failure, and, while treatment impacts everyone differently, she is back to her activities and has not been hospitalized for the condition, which drives approximately 900,000 to the hospital each year.
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In addition to medications, Michele altered her lifestyle to manage her condition by walking more often and reducing her salt intake.
During American Heart Month and Black History Month, we wanted to explain what heart failure is, the signs, and what to do about it.
We sat down with heart failure patient, Michele and the Director of the Heart Failure Disease Management Program at TriStar Centennial Medical Center in Nashville, TN, Beth Towery Davidson, to discuss real-life symptoms, practices, and the outcomes of this condition:
Diagnosed with Heart Failure
BlackDoctor.org (BDO): When were you diagnosed with heart failure, and what were your symptoms?
Michele N. (MN): I was diagnosed about 2 and a half years ago. The first thing I noticed walking from work across the street to the parking lot is that I had to stop several times just to catch my breath. I was having labored breathing. Then, I had swelling in my feet, ankles and in my calves. I also had chronic fatigue. So, I knew that something was wrong so I made an appointment with my family doctor.
I actually thought it was allergies or asthma. I had to go back 2 or 3 times before she recommended that I go see a cardiologist. After I made the appointment with the cardiologist, he ran some tests on me to find out that I did indeed have heart failure.
BDO: Before you were diagnosed did you know much about heart failure and the signs to look out for?
MN: I did. My mother had passed away in 2004 from heart failure complications and I know that she suffered from labored breathing and swelling. She actually had a lot more swelling around her heart which meant that she had to go into a hospital several times in order to get that fluid extracted from around her heart. So, I knew a little bit about it.
Diet and Lifestyle
BDO: If you could think back, what was your diet and lifestyle like during that time?
MN: My diet wasn’t good. I moved from California to East Tennessee where there is a lot of fast food and high sodium foods that I was eating. The problem was that I wasn’t exercising. I really wasn’t paying attention to myself. I was just masking things off as something else other than what I thought it could be. If I were to go back, I would do things differently.
BDO: How do you manage your cardiovascular failure today?
MN: With a low to no sodium diet. I increased my activity. I sit in front of a computer all day so I manage to get up every hour and move around. Then, I walk around the building, walk around the office, go home walk the puppies more in the evening. I am also on a medication that my doctor introduced me to, Entresto, and I just take it according to the instructions that he has given me.
What is Heart Failure?
BDO: Beth, as a medical professional, can you give us the definition of heart failure? What are its most common symptoms, and why are Blacks at an increased risk?
Beth Towery Davidson (BTD): Heart failure is a chronic, progressive condition. It's where the heart cannot pump enough blood and oxygen to meet the demands of the body.
Because of this ineffective pumping, the most common signs are 1. shortness of breath, 2. fatigue, and 3. swelling in the feet, the legs, and the abdomen.
Blacks are definitely at an increased risk because they have other comorbid conditions that could pre-expose them to heart failure. In the Black community, we know that there is a lot of uncontrolled high blood pressure. That often leads to chronic kidney disease. There’s a lot of obesity. Not having an ideal body weight can be a risk factor for heart failure.
BDO: Why is the need for hospitalization a sign of danger for people dealing with heart failure?
BTD: If a patient has a heart failure hospitalization, it is truly a red flag. It is sort of saying aloud that the condition is progressing or it’s worsening, it’s in deterioration.
It is a progressive disease, so if you have a heart failure hospitalization it is a very appropriate time to talk to your healthcare team about your chronic treatment strategy.
Managing Heart Failure
BDO: How can people manage it to help keep them out of the hospital?
BTD: 1. Limiting sodium or salt in your diet because salt turns your body into a sponge and you already have extra fluid. 2. We want you to stay physically active and have periods of activity with rest because we want you to work that heart a little bit. And lastly, 3. Medical therapy because there’s clear directed guideline medical therapy available to you.
As Michele mentioned before, Entresto, was actually in a very large clinical trial that proved to keep patients alive.
It also kept patients out of the hospital longer than a leading heart medication. There are even additional data recently that shows that this therapy can be used in patients that are hospitalized with heart failure after they’ve stabilized.
So, all of those are real simulations to that data, and it’s worth the consideration.
Medications
BDO: Is Entresto a medication that a lot of medical doctors already know about? Is this something that the patient would have to request from their healthcare provider?
BTD: It can depend on your provider, Entresto has been available on the market for several years now so clearly cardiologists and heart failure teams are absolutely aware of it. I do think it’s becoming more commonly prescribed by primary care physicians.
For more information on heart failure visit our Health Conditions page on BlackDoctor.org. Find out additional information on Entresto at www.entresto.com.
Disclaimer: Entresto is a prescription medicine. It is used to reduce the risk of death. It also reduces hospitalization in people with certain types of long-lasting (chronic) heart failure. Entresto is usually used with other heart failure therapies, in place of an ACE inhibitor or other ARB therapy. Entresto can harm or cause death to your unborn baby. Talk to your doctor about other ways to treat heart failure if you plan to become pregnant. If you get pregnant while taking Entresto, tell your doctor right away.
