The pandemic stretched healthcare infrastructure of even the most developed countries and today, over a million people have succumbed to the novel coronavirus worldwide. While some people who contract the virus are asymptomatic, others with a compromised immune system may experience severe symptoms. The virus poses a particular risk to people over the age of 60, and those with underlying medical conditions including heart failure, hypertension, and diabetes. This fact is even more alarming for a country like India that has 40 percent of world’s 2.6 crore heart failure cases.
Delving deeper into heart failure and its treatment
People with pre-existing cardiac problems are hospitalised if they fall prey to COVID-19. Once the coronavirus enters a human body, it causes direct damage to the lungs triggering an inflammatory response that may worsen cardiac function and exacerbate symptoms in patients with heart failure.
Now let us understand what heart failure is. Heart failure is a disease in which the heart is unable to pump adequate oxygenated blood to meet the needs of the body. This leads to high blood pressure, water retention, tissue swelling, fatigue and shortness of breath. Heart failure does not mean that that heart stops functioning completely. The heart continues pumping, but not as efficiently as a healthy heart. The disease generally results from other underlying conditions such as previous heart attack, narrowing of the arteries that supply blood to the heart muscle, heart valve disease, high blood pressure, congenital heart defects, cardiac arrhythmias, among others.
Symptoms of heart failure depend on the pumping capacity of the heart. Some people experience symptoms like fatigue, weakness, and shortness of breath due to insufficient blood supply. And some develop signs like shortness of breath while lying down, weight gain, persistent cough, nausea, abdominal pain, poor appetite, leg swelling and persistent cough because blood and fluid become congested before they reach the heart.
Why are early diagnosis and timely treatment pivotal in managing heart failure?
There is no known cure for heart failure, however, early detention and timely medical intervention along with certain lifestyle changes can help in managing the symptoms. When a person visits the doctor with heart failure symptoms, a physical examination is conducted first during which the doctor checks the patient for problems like heart enlargement, irregular heart sounds, water retention and swelling or tenderness of the liver. This is followed by blood tests, x-rays, an electrocardiogram, ECG test and several other tests that will help to diagnose heart failure.
After successful diagnosis, doctor can recommend treatment options include medications, implantable devices, and surgeries. Credit it to years of research and innovation by scientists, in the last two decades, we now have an influx of minimally invasive techniques through which patients with heart failure can manage their symptoms better. For instance, complications such as heart valve defect and blocked arteries can be treated with technologies such as cardiac resynchronization therapy (CRT). CRT has helped in reducing hospital stays, prevented the disease symptoms from aggravating and given patients a better quality of life.
The therapy helps to detect abnormal heartbeats. It comes with an in-built implantable cardioverter defibrillator (ICD) that delivers electrical pulses to restore normal heart rhythm. Here, it is critical to note that patients with heart failure are at an added risk of sudden cardiac death. Like any other device, CRT-D runs on batteries that deplete with time. However, as the battery is sealed inside the device, it is unsafe to change it repeatedly. Earlier, the entire device had to be replaced after every three to seven years which also increased the risk of infection and treatment cost. As healthcare technologies have made significant stride in India, we now have devices that run on batteries that last for at least 13 to 16 years, eliminating the need of repeating the implant.
The National Institute for Health and Care Excellence (NICE) technology-2017 appraisal guidance on implantable CRT-D devices for arrhythmias and heart failure recommended, “There is good evidence to support the clinical benefit of longer battery life and the associated reduction in CRT-D replacements.” NICE is a non-departmental public body that provides national guidance and advice to improve health and social care in England.To fight the whopping incidence of heart diseases, cardiac care has witnessed remarkable breakthroughs in India. Even when we have innovations aiding better patient outcomes, spreading awareness about their usage is the key.
(Disclaimer: The author is Dr. Ashutosh Kumar, Consultant Cardiologist and Electrophysicist, Continental Hospitals, Hyderabad. Views expressed are a personal opinion.)