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Congestive Heart Failure: Role for Early Identification and Early Intervention

Doctorpedia Editorial Team Doctorpedia Editorial Team August 5, 2021
Medically reviewed by Susan Kerrigan, MD and Marianne Madsen

Congestive heart failure, also sometimes known as heart failure, is a condition where your heart cannot pump enough blood to meet your body’s needs. It is caused by any disorder that impairs the filling or ejecting of blood through the heart’s ventricles. 


Recent research estimates that around 5.1 million people in the U.S. currently suffer from heart failure, with around 650,000 new cases being diagnosed each year. According to the Heart Failure Society of America, about 8.5% of all heart disease deaths in the United States are officially caused by heart failure. However, some suspect that the figure may be closer to around 36% of all cardiovascular disease deaths. 


Treatment for heart failure is currently focused on reducing the condition’s symptoms, such as shortness of breath, tiredness, fatigue, low blood pressure, and an increased heart rate.


Diagnosing Heart Failure


Doctors will normally make a diagnosis only once a patient presents with symptoms of heart failure. To make their diagnosis, they will typically order an echocardiogram (echo) to determine the strength of the patient’s heart. The echo tests the heart’s wall thickness, blood flow through its valves, and ejection fraction (EF). 


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Congestive Heart Failure - Testing

Congestive Heart Failure - Testing

The heart’s EF is a measurement, usually expressed as a percentage, of how much blood the left ventricle of the heart pumps out. According to the American Heart Association, a healthy heart typically has a cardiac output of between 50-70% of the total blood in the ventricle. Higher than 75% cardiac output and the patient may have a condition called hypertrophic cardiomyopathy, but lower than 40% and they may be suffering from heart failure.


The Need for A New Approach


More recently, doctors and medical professionals have begun to look at the benefits of diagnosing and treating patients earlier in the course of their disease. There are two pressing reasons for this. Firstly, because most of the people diagnosed are 65 and older, many predict that the number of patients will only increase in the future. Secondly, there is the economic burden. Suppose more patients need medical care. In that case, more money will need to be spent treating the disease leading to costly health outcomes. By 2013, heart failure costs in the U.S. had exceeded $30 billion, so reducing the future economic burden of medical care costs is crucial.


Early Identification and Earlier Treatment


The developing belief is that if heart failure were identified earlier, treatments like vasodilator drugs that open blood vessels would be used earlier.  The effect would be more people with milder, less advanced heart failure, which would ultimately help lower mortality rates. The newer staging of heart failure has Stage A: Those at risk of having congestive heart failure.  These are people with the predisposing conditions for  CHF.


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Congestive Heart Failure - Ejection Fraction

Congestive Heart Failure - Ejection Fraction

Similarly, earlier treatment of a patient with angiotensin-converting enzyme (ACE) inhibitors might help decrease mortality levels and reduce overall symptoms of heart failure. Earlier treatment for heart failure with ACE inhibitors may also prevent the patient’s heart from increasing in size due to the condition.


Early Identification Methods


The benefits of diagnosing a disease early in its onset seem to be obvious. Earlier identification of patients means earlier intervention, which means a better chance of successfully treating the condition. The question remains of how a doctor can identify heart failure as early as possible.


A 2015 study looked at whether data stored as part of every person’s electronic health record (EHR) could be used with advanced machine learning techniques. The research team sought to create an algorithm that might highlight cardiovascular risk factors that could be early markers of the disease. They could then use this information to predict the chances of a person developing heart failure. The researchers found that they could predict the onset of heart failure up to two years before diagnosis with a high degree of accuracy. If this study can be replicated on a larger scale, this would help doctors intervene even before the condition has developed.


Aggressive attention to addressing the predisposing risk factors could delay the disease progression. With early identification and intervention, many patients with heart failure might enjoy a more normal life expectancy. Treating the condition early in its onset or even pre-diagnosis appears to lower mortality rates and allow patients to live as regular a life as possible.

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