Seniors: Is Your Heart Failing You?

Cornelius E. Brown, PharmD Candidate 2008
Shenandoah University
Prepared during Consumer Health Information Corporation Clerkship
McLean, VA

I can recall having a casual conversation with my sister one Saturday afternoon and one question during our talk caught me by surprise.  She asked, “What do you learn in pharmacy school?”  My first reaction was to say, “What do we NOT learn in pharmacy school?”  Instead, I laughed a little, and then gave it my best shot.  I replied, “Well, we learn about medications, dosing, side effects, disease states, therapeutics, common health issues, etc.”

One health issue in particular that hits very close to home is heart failure.  We lost our grandmother suddenly to this condition after my second year of school.  She had suffered quietly for years and did not take her medicines.  Instead, she was busy taking care of others.  As I reflect on such a difficult time, I felt the impact this health problem can have on others.  My family has not fully recovered from losing such an important pillar in our family.  Sharing what I learned about heart failure can help seniors do something about it now before it is too late.

What is heart failure?

Heart failure does not always mean that the heart has stopped beating.  In most patients, it occurs when the heart cannot pump enough blood around the body to feed the cells and tissues.  The body tries to increase the heart’s pumping action by increasing the size of the heart and raising blood pressure.  Over time, the heart becomes over-worked.  In some, it may stop completely leading to death.  Conditions such as clogged blood vessels, heart attack, high blood pressure and many other health problems can lead to heart failure if left untreated.

Of the 300 million persons in the United States, 1 in 60 lives with heart failure.  It occurs  more often in the U.S. elderly population each year and is the most common diagnosis for patients over the age of 65 upon discharge from the hospital.  A study by the Duke Research Institute states that the number decreased among the very elderly, but is increasing for those between the ages of 65 and 69.  According the Center for Disease Control, about 287,000 people die each year due to complications of heart failure.

With new, and often expensive, medications available on the market each year, many seniors do not fill all of their prescriptions because of high out-of-pocket expenses, side effects, or they forget to take their medicine.  About 1 in 3 seniors stop taking their medications if they feel the medicine is not working.  Patients often do not communicate this information to their healthcare providers.  When this happens, physicians believe that the medication is not working and may increase the dose or change the medication.  Many times, the problem is that the drug has not been taken!  In the long run, untreated health problems will increase overall healthcare costs.

“How would I know if I have heart failure?”

Not everyone has the same symptoms but the most common complaints that people with heart failure are:

• “I can hardly breathe after walking up a flight of stairs.”
• “I feel really tired and this is not normal for me.”
• “I am coughing (or wheezing) and don’t know why.”
• “My ankles are swollen.”

Some other symptoms may include unusual fatigue, sudden weight gain, and loss of appetite.  Some patients have to sit upright in order to breathe easier, use extra pillows at night to sleep, or elevate their feet for relief.  See your healthcare provider immediately if you have any of these symptoms.

Lifestyle Changes

Lifestyle changes are important and play key roles in managing heart failure.  Here are six activities that can reduce risks:

• Eat meals consisting mainly of fruits and vegetables that are low in fat and calories.
• Reduce salt intake.
• Reduce alcohol consumption.
• Exercise for at least 30 minutes a day most days of the week.
• Lose weight.  Record weight at least 3 times a week.
• Stop smoking.

Medications work only when taken

Many patients will have to take medications for the rest of their lives when heart failure does occur.  Doctors will use various medicines based on symptoms and count on patients to take them correctly.  Medications only work when patients take them.  Forty percent of seniors do not take their medications as prescribed.  Some of the reasons are costs, side effects, the patient feels that the medicine is not working, or they simply forget.  When medications are not taken correctly, symptoms could worsen, blood pressure could increase, or the heart could develop an irregular rhythm.   It is alarming that 90% of heart failure patients will return to the hospital when medications are not taken correctly.

Take charge of your medicines

Here are some important tips to make sure you get the most benefit from your medicines:

• Do not stop taking medications without talking to your doctor.
• Ask questions if your health condition or medication directions are hard to understand. 
• Pharmacists can help your doctor choose medicines that are inexpensive and easy to take. 

Heart failure treatment does not have to drain your bank account.  Many drugs have low cost generic equivalents and can be purchased at pharmacies with discount medication programs.  Often, pharmacies can set up electronic or mail reminders to help patients keep track of refills.  Close monitoring and routine follow-up with a healthcare provider can aid in management of possible side effects that can occur when taking medications. 

Don’t wait.  Ask now!

Ask your doctor or pharmacist before stopping a medication or if you are experiencing unwanted side effects.  Physicians cannot adjust your medications if you do not tell them they are causing you problems. 

Follow up with a healthcare professional regularly and keep your pharmacist informed of any changes in prescriptions, over-the-counter and herbal medications.  When combined with lifestyle changes, this will help increase the chance for a longer life for you and your family. 

My grandmother dedicated most of her life helping others at the expense of her own health.  I intend to carry on her love of helping others throughout my career as a pharmacist so that other families can have their loved ones around a bit longer as I would have liked.

© 2008 Consumer Health Information Corporation. All rights reserved.