6.8% of Spaniards over 45 years of age and nearly 20% of those over 85 suffer from heart failure (1). A chronic and degenerative pathology that is characterized by weakening the heart and its ability to pump enough blood to meet the body's needs and that can take years to present the first symptoms. These, in addition, tend to be non-specific and are sometimes shared with other pathologies, which makes their early diagnosis even more difficult and, as a consequence, worsens their prognosis. In fact, heart failure is the leading cause of hospitalization in people over 65 years of age in Spain, it represents approximately 5% of those registered in the country and its diagnosis is associated with nearly 20,000 deaths per year (2,3,4) . A complex diagnosis that adds to the need to promote a comprehensive approach to the syndrome to improve its prognosis.
Improving the evolution of heart failure and the quality of life of those who suffer from it involves promoting knowledge of this pathology among the population and healthcare personnel. It is also essential to know its risk factors, the diseases with which it is associated, its main symptoms or the importance that prevention and early diagnosis play in its evolution. Added to all this is the need to establish appropriate treatment for each patient who, for their part, must be aware of the need to follow medical recommendations and controls. The Boehringer Ingelheim and Lilly Alliance work along these lines. As its spokesperson, Arantxa García, points out, “we are committed to improving patient care. Therefore, we work every day to understand their needs, expectations and the challenges they must face in the current therapeutic and health field. Including their perspective helps us optimize tools that allow better management of heart failure and associated pathologies.
Thus, within the framework of this World Heart Day, we reinforce the importance of both patients and caregivers as well as society in general being informed about the interrelationship between the cardiovascular, renal and metabolic systems, with the aim of being able to monitor comprehensive treatment of their pathologies and to be able to avoid or delay the appearance of other related conditions and therefore contribute to the improvement of their illness and quality of life.”
One of the peculiarities of heart failure is the complexity of its diagnosis, which lies in the fact that this condition may not present symptoms for a long period of time. Likewise, when these appear they can be nonspecific, which makes it easier to confuse them with other pathologies. As a consequence, health personnel usually require complementary diagnostic tests – such as cardiac ultrasound, determination of urea and electrolytes or blood count – that allow them to establish a definitive diagnosis and appropriate treatment for each patient.
In this sense, current guidelines (5) recommend an interdisciplinary approach and care that ensures adequate and early treatment for heart failure patients, especially from primary care (6). It is in these centers that the first symptoms are usually detected and whose suspected diagnosis and management of this condition could reduce the associated hospitalizations and mortality. Among the main symptoms of heart failure, which can vary between individuals, the following stand out: difficulty breathing, especially when lying down, or feeling short of breath; fatigue and muscle tiredness, which may be more obvious in the face of efforts that would not have caused it before; swelling in ankles, legs and abdomen; loss of appetite or feeling of fullness; dry cough; and tachycardia or palpitations.
Regarding the causes of its appearance, aging and the development of other cardiovascular pathologies stand out, such as angina pectoris, heart attack, atrial fibrillation, myocarditis or diseases of the heart muscle, but also other conditions of the cardiovascular system, renal and metabolic due to the interconnection that exists between them. In fact, this relationship is so close that heart failure can be both the cause and the consequence of other cardiac, renal or metabolic pathologies, and improve the health of any of these systems, as well as control the risk factors associated with the development of their typical pathologies, will impact the health status of others (7,8,9). This is the case, for example, of type 2 diabetes.
On the one hand, this pathology is one of the factors associated with heart failure, increasing the chances of suffering from it between two and four times (11), in addition to increasing the risk of the most serious consequences of the disease appearing, such as hospitalization and death (10). On the other hand, patients with heart failure have four times the prevalence of type 2 diabetes mellitus (11). Something similar occurs with kidney disease, since the presence of heart failure seems to accelerate the presence and progression of kidney disease, and vice versa. Likewise, when both pathologies occur, the risk of hospitalization, rehospitalization, need for intensive care or renal replacement therapy, and death increases (12,13,14). Likewise, as the severity of chronic kidney disease increases, so does the prevalence of heart failure, with approximately 44% of hemodialysis patients suffering from it.
