Catching heart failure early

Earlyto reduce diagnosis the is incidence crucial of death, sickness and high healthcare expenses caused by Heart Failure (HF) or pumapalyang puso. Unfortunately, HF is hard to catch and is often under-diagnosed or even misdiagnosed. Here are some facts and figures: A 2014 survey of 11,000 members of the public in Europe aged 50 years and older found that fewer than 1 in 10 people can identify three common symptoms of HF: severe breathlessness, swollen ankles, rapid weight gain and difficulty moving1. Around 1 in 3 people mistake HF symptoms as normal signs of aging2. 1 in 4 people would wait a week or more to seek medical advice, or would not seek medical advice at all when experiencing HF symptoms3. 1 in 5 HF patients in Japan, the US and EU are diagnosed when the condition is already at its most severe stage3. These data indicate that low public awareness on HF and its symptoms is a key factor. However because HF is not symptom specific, diagnosing HF can also be a challenge for healthcare professionals. For example, 21% to 30% obstructiveof patients pulmonarywith chronic disease (COPD) have unrecognized HF4. Whereas nearly 100% of cardiologists in the UK use echocardiography to diagnose HF, less than 50% of general practitioners in that country utilize this imaging modality, which is a cornerstone in diagnosing and managing HF5. Public awareness on HF signs and symptoms must be increased. Aside from the three already mentioned, other common HF symptoms include rapid or irregular heartbeat, persistent cough or wheezing with white or pink blood-tinged phlegm, increased need to urinate at night, swelling of abdomen (ascites), lack of appetite and nausea, difficulty concentrating or decreased alertness, and chest pain if HF is caused by a heart attack. See a doctor immediately if you or a loved one develops any of these signs and symptoms. Diagnosis and referral protocols for HF are available and should be followed by healthcare professionals, particularly primary care physicians. Theselines of includethe Americanthe latest guide-Heart Association (AHA) and European Society of Cardiology (ESC). HF should first be evaluated based on the patient’s clinical history, symptoms, physical examination and resting electrocardiogram (ECG). ECG is the most useful test to establish the diagnosis of HF and determine appropriate treatment. Making prompt referral and treatment decisions is important to im- prove patient functionality, quality of life and reduce hospitalization. Outpatient HF screening for at-risk patients should be routinely done. Although there are currently no definitive local statistics on the prevalence of HF, the latest National Nutrition and Health Survey (NNHeS) conducted in 2013 showed that many Filipinos have risk factors for HF. These include hypertension, obesity, smoking, high cholesterol and diabetes. With increased public awareness, enhanced screening and prompt referral at the primary care level, HF can be diagnosed early and its lifethreatening complications prevented or managed.

Dr. Raul L. Lapitan is the current President of the Philippine Heart Association (PHA). He earned his medical degree from the Far Eastern University- Nicanor Reyes Medical Foundation, and completed his residency training in Internal Medicine and Fellowship in Cardiology at the Makati MedicalCenter. The PHA is an organization dedicated to ensuring compassionate and quality cardiovascular care. For more information, visit www.philheart.org References:

1. RTNS UK Limited, March 2014. Survey of 11,000 members of the public aged 50+ years old in Europe, funded by Novartis

2. Remme WJ, et al. Public awareness of heart failure in Europe: first results from SHAPE. European Heart Journal. 2005;26:2413-2421.

3. Joseph, L., Dandamudi, N. Chronic heart failure – Disease Coverage. Datamonitor Healthcare. 2016.

4. Abroug F. Ouanes-Besbes L. Detection of acute heart failure in chronic obstructive pulmonary disease patients: role of B-type natriuretic peptide. Curr Opin Crit Care. 2008;14:340–347.

5. Hancock H.C., et al. Barriers to accurate diagnosis and effective management of heart failure have not changed in the past 10 years: a qualitative study and national survey. 2014. BMJ Open