Many people mistakenly believe that heart failure is an abrupt stopping of the heart. In fact, heart failure usually develops over time. It is a condition that occurs when the heart is unable to contract or relax properly. As a result, the heart cannot pump enough blood to meet your body’s needs Depending on the level of severity, heart failure may or may not be immediately life-threatening. However, it is typically a chronic (long-lasting) condition that worsens over time and needs treatment. There is no cure, but many people with heart failure who receive proper treatment go on to live long, full and enjoyable lives.

What are the causes of heart failure?

▪       Coronary artery disease

▪       High blood pressure

▪       Heart valve diseases

▪       Heart defects present since birth

▪       Diabetes

▪       Heart muscle diseases

▪       Infection of the heart and/or heart valves

▪       Damage to the heart muscle from a heart attack

What are the symptoms of heart failure?

If a patient notices certain symptoms that are affecting his day to day activities like –

▪       Easy fatiguability

▪       Shortness of breath on exertion or at rest

▪       Generalized weakness

▪       Swelling, especially the legs and ankles

▪       Frequent dry, hacking nocturnal cough, nocturnal increased urine frequency

▪       Loss of appetite

▪       Sudden weight gain

How heart try to accommodate?

To make up for its decreased ability to pump blood, the heart and body may make changes to adapt:

▪       The heart may become enlarged, stretching its chamber.

▪       Heartbeat faster.

▪       The body may divert the flow of blood away from less important tissues and organs so that vital organs such as the heart and brain have an adequate supply.

These adjustments may help for a while, but eventually, the heart’s inability to pump worsens and the patient may begin to notice symptoms.

How big this problem is?

Heart failure (HF) is a global pandemic affecting at least 26 million people worldwide and is increasing in prevalence.

One large trial published in cardiac failure review 2017 data showed that in 2012 heart failure was responsible for an estimated health expenditure of around $31 billion, equivalent to more than 10 % of the total health expenditure for cardiovascular diseases in the United States (US). Projections are even more alarming, however, with total costs expected to increase by 127 % between 2012 and 2030 and India the estimates range between 1.3 and 4.6 million, which translates to a prevalence of 0.12–0.44 %, although this may be underestimated.

Indian data is still not up to the mark but trial published in lancet 2017 clearly showed that heart failure is alarmingly increasing in developing countries as compared to developed countries.

The study, published on May 2, 2017, has found that heart failure patients in India had one of the highest mortality rates after one year of diagnosis at 23%. This was more than the mortality rates of patients in Southeast Asia (15%), China (7%), South America (9%) and West Asia (9%). Only patients from countries in Africa had a higher mortality rate at 34%. The study also highlighted that heart failure patients in India, Africa, and Southeast Asia were approximately 10 years younger than patients in the U.S. and Europe.

Census of many trials showed that average age of presentation in developing countries is 53 year and in developed countries it is around 73 years, in-hospital mortality difference is 3-4% v/s 25-30 %, & post-discharge mortality is 8-10% v/s 25-30% , So India like countries are affected at younger age with high in-hospital & post-discharge mortality.

How much EF (Ejection fraction) is safe?

Normal EF (Ejection Fraction is between 60-70 %), Above 40% of heart patients are comparatively safe, lower the EF higher the mortality.

How can we decrease recurrent Hospital admissions in Heart failure patients?

–        Reduce salt intake to less than 2 gm/day. Normal intake is roughly 6 gm /day.  If ejection fraction less than 20 % then further decrease salt intake to less than 1 gm/day.

–        Fluid intake in summers 1500-2000 ml according to perspiration level, in winters 1200-1500.

–        Regular weight check – if a sudden increase of 3-4 kg in a month consult a doctor

–        Regularly take prescribed medications  by your doctor & follow up as advised , heart failure patients have low blood pressure & they are prone for renal & liver problems added to that drugs also have their effects on these two organs so additive risk is there for other organs, that’s why regular visit & blood investigations are advised to heart failure patients.

Heart failure patients are prone to VT (ventricular tachycardia) in simple language short-circuiting in the heart that is a life-threatening condition & to decrease this AICD (a device that senses this & generates shock to stop this) is strongly recommended in these patients. If heart failure fulfills certain criteria of dyssynchrony between two ventricles, then some improvement in EF can be done by placing CRT (Resynchronization device) to the patient. CRT is the only option left before Heart transplant that showed mortality benefits in such critical heart failure patients.

CRT & AICD are basically advanced pacemakers with added features that are placed with our major surgery & with excellent long term results.


Dr. Rudra Dev Pandey
Dr. Rudra Dev Pandey

Senior Consultant - Cardiology
Department of Cardiac Sciences

Dr. Sunil Beniwal
Dr. Sunil Beniwal

Senior Consultant - Cardiology
Department of Cardiac Sciences