Heartfelt Challenges: A Closer Look at Heart Failure in the Elderly

Malaysians are diagnosed with heart failure at a younger age compared to other Asian countries. (60-69 years old compared to 66-81 years old globally.) Not only that, we have the highest rates of developing heart failure in South East Asia. In 2017, 721 in 100,000 Malaysians were diagnosed with heart failure.

Unfortunately, the numbers are only expected to increase.

Heart disease is the number 1 killer in Malaysia (18.4% in 2022), and heart failure falls under the umbrella of these diseases.

What is Heart Failure?

In simple terms, heart failure can be described as a heart that is not functioning properly.

It means that the heart cannot fully meet the requirements of energy and nutrients for our cells and tissues to stay healthy and function properly.

The heart cannot generate enough strength and power to pump blood to all tissues and organs in the body. This causes a lack of oxygen and nutrients supplied to the body.

Heart failure is more common amongst the elderly compared to other forms of heart diseases such as heart attacks, valvular heart disease (where heart valves which are known to help our hearts pump and keep blood flowing are damaged) and heart arrhythmia – a condition of faulty series of electrical impulses of the heart, causing an irregular heartbeat.

Types of Heart Failure

Heart failure can involve either the right side or left side of the heart, or possibly even both sides.

There are 3 types of heart failure, depending on how efficiently the left ventricle can generate enough force to pump blood to the entire body. This is also known as ‘ejection fraction’, a term your doctor might use while describing heart failure to you.

Ejection Fraction

Heart failure (HF) comes in three different types:

Heart failure with reduced ejection fraction (HFrEF) – Ejection fraction is <40%
Heart failure with midrange ejection fraction (HFmrEF) – Ejection fraction is 40-49%
Heart failure with preserved ejection fraction (HFpEF) – Ejection fraction is normal at ≥50%

Am I At Risk of Developing Heart Failure?

You are at risk if you have

High blood pressure

High blood pressure can cause your heart to enlarge (left ventricular hypertrophy) and damage heart tissues (fibrosis) over time.

It will impair the heart’s ability to contract and relax.

Men who have high blood pressure are twice as likely to develop heart failure, whereas women are three times more likely to develop this disease.

An underlying Coronary Artery Disease

There is a higher risk of developing HF if you have had a heart attack or unstable angina in the past.

Increasing Age

HF is common, due to the degenerative changes of heart muscles as one ages.

Valvular heart disease

There are 4 valves in our heart – tricuspid, mitral, pulmonary and aortic valves.

Valvular heart disease can be congenital (from birth) or acquired.

Stenosis is the narrowing of valves. It can be due to atherosclerosis, preventing blood from flowing into the next chamber. In turn, it causes a backup of blood in the chamber.

Regurgitation is leaky heart valves. It leads to backflow of blood back into the heart chamber, making it harder for the heart to pump extra blood to the rest of the body.

Arrhythmias

An irregular heartbeat, be it too fast or too slow, can impair the heart’s ability to generate enough force to pump blood efficiently.

Sleep apnea

It is a serious sleeping disorder which causes you to stop breathing when you sleep. One of the main causes is obesity. You may have sleep apnea if you snore loudly and feel like you did not have a good night’s rest after waking or sleepy throughout the day.

Anaemia

Low haemoglobin levels can trigger heart failure.

Diabetes

Diabetes mellitus is a condition of high blood sugar levels.

Obesity

According to the Malaysian Community Practice Guidelines, a BMI of >27.5 kg/m2 is considered obese. Waist circumferences for both men and women are at least 80 and 90 cm respectively.

Viral infections

Infections may also damage heart tissues and cells.

Alcohol

Alcoholism can weaken and damage heart muscles.

Smoking

Chronic smoking and use of tobacco increases your risk of developing atherosclerosis which can cause heart failure.

Signs and Symptoms

It is harder to diagnose heart failure in the elderly because they do not present with typical symptoms.

They often have vague symptoms – which are breathlessness and tiredness.

Other symptoms include:

Progressive swelling in lower legs starting from the toes, moving upwards to ankles, knees and thighs
Requires at least 2 pillows to sleep without feeling breathless or discomfort.
Waking up at night gasping for air
Breathlessness doing simple activities, at rest or lying down
Tiredness during exertion or doing simple activities
A cough that has white or pink sputum
Nausea
Reduced appetite
A feeling of fluttering in your chest, irregular heartbeat
Chest pain, which may indicate the possibility of a heart attack

Acute Heart Failure

If you develop symptoms like

Feet, ankle or leg swelling
Chest discomfort/ tightness
Confusion
Dizziness
Drowsiness, reduced alertness
Cough (pink or white phlegm)

Seek urgent medical attention or go to the hospital immediately!

Hypothyroidism, infections, chronic obstructive pulmonary disease (a disease of the lung), anaemia or a heart attack can trigger an episode of acute heart failure.

What Can I Do to Prevent Heart Failure?

A Healthy Heart, A Happy Life

A Well-Balanced Diet

Prevention is better than cure.

Avoid foods that are highly processed, deep-fried and refined sugars.

These include fast food, chips (as tempting and tantalising as they may be!), cookies, cakes and sugary beverages (including fruit juices).

Avoid red, fatty meat which can increase the risk of gout.

Instead, fill yourself up with dietary fibre – fruits and vegetables. They also reduce the risk of diabetes and high cholesterol levels, which are risk factors for HF.

Elderly people are at risk of malnutrition- due to the reduction of appetite due to ageing, swallowing and chewing disorders. Talk to your medical doctor or dietitian to come up with a dietary plan and a soft food diet.

Exercise

Exercise is beneficial for all ages.

There is an overall lower risk of all-cause mortality, heart diseases, high blood pressure, diabetes, dementia and falls. There is an overall improvement in quality of life, sleep, bone health, weight loss and more. Elderly individuals who are physically active are healthier and spend less on medical bills as compared to those who are sedentary.

They are stronger, more flexible and mobile. Most importantly- they can maintain their level of independence.

It is never too late to start exercising!

A daily morning walk, stationary bicycles, a group taichi session, a 20-minute stretching exercise, a 30-minute YouTube exercise with 1 – 2 kg dumbbells – the list is endless.

Group workouts are also wonderful opportunities to meet old friends and make new ones. Moreover, social interaction can reduce the risk of depression.

Maintain a healthy weight

This is also beneficial for overall health and well-being. Sleep apnea and obesity are causes of heart failure.

Stop smoking

It is often easier said than done. Don’t hesitate to talk to your medical doctor about joining a smoking cessation programme to snuff it out for good.

Reduce consumption of alcohol

Alcohol abuse is a trigger factor for acute heart failure and may even worsen heart failure.

Go for yearly check-ups

Get your blood tested. Body scans like X-rays and ultrasounds. Full body check-ups can detect any illnesses early and manage them more effectively.

Don’t miss your medications!

Most people who are diagnosed with heart failure already have underlying diseases like diabetes, high blood pressure and high cholesterol. In managing these illnesses well, we can prevent complications including heart failure.

I’ve just been diagnosed! What Should I Do Now?

Unfortunately, heart failure is not curable.

The goal of treatment is preventing deterioration.

Medication

Your doctor may prescribe you medications for your heart.

Diuretics help to control heart failure symptoms and prevent fluid retention (leg swelling, breathlessness due to fluid in lungs, generalised body swelling). It is important to take your medications on time and go to all of your appointments.

Low sodium diet

Consume less than 3g of sodium intake a day. The amount may be less for those with severe heart failure.

You can use seasonings, herbs and spices in cooking to add that extra flavour!

Fluids restriction

This is only for severe heart failure. Your doctor may ask you to restrict fluid intake from 500 ML to 2 litres a day.

Monitor your blood pressure and weight daily.

Keep a chart of your measurements and bring them to your doctor during follow-ups.

Maintain or lose weight

If you are obese or overweight, your dietitian may counsel you on a weight loss plan.

Stop smoking

Abstinence from alcohol.

Your doctor may suggest devices to treat heart failure including:

Implantable Cardioverter-Defibrillators (ICDs) – detect when the heart is beating irregularly, and correct it. This lowers the risk of developing a heart attack
Cardiac Resynchronization Therapy (CRT) – only for advanced stages of heart failure and persistent symptoms despite being on medication and lifestyle changes.
Left Ventricular Assist Devices (LVADs)

However, not all elderly patients are fit enough to undergo surgery and may be managed conservatively with medications and lifestyle modifications.

The Heart of the Matter

Health is wealth.

If you observe symptoms in your loved one that closely resemble those of heart failure, it is crucial to promptly consult with a doctor today!