Invisible heart failure: women suffer from it earlier and more often than men, say UMCG specialists | Public medical academy

There’s a myth that cancer happens to you and heart failure is your fault, says cardiologist Daan Westenbrink. What isn’t even true is that people with heart problems can live very old if they are diagnosed and treated early. In fact, many cancers, such as prostate and breast cancer, have a better life expectancy than heart failure.

Westenbrink specializes in “invisible” heart failure at UMCG. Together with cardiologist-in-training Laura Meems, he runs a clinic of the same name at UMC Groningen. People who are suspected by their primary care physician or hospital that they are suffering from invisible heart failure are examined in the office with advanced techniques, after which they are advised which method of treatment is most suitable for them.

Heart failure is a difficult disease to determine

Invisible heart failure. What is that? To understand this, we must first process heart failure, let’s say its visible variant. According to Westenbrink, this has been known for several centuries. Doctors used to detect this ailment when they opened deceased patients and saw that they had an enlarged heart.

In a patient with ailments, however, this is much more difficult to determine. Westenbrink: ,, It is a difficult disease to determine. Many complaints – such as shortness of breath and waking up at night with the urge to urinate – are also associated with old age. When does it matter? When is it due to lack of physical fitness? When are lungs or other diseases responsible? ”

If someone comes to the family doctor with these complaints, it is their job to make an initial diagnosis. For this they can measure the pulse, detect abnormal sounds in the body with a stethoscope, take a picture of the lung, determine blood pressure, take a blood sample. If the patient is estimated to have a heart condition, he is referred to a cardiologist in the hospital. Westenbrink: ,, Standard, an ultrasound of the heart is done. Then the pump power is measured. A heart with a reduced pumping function can be seen well with the naked eye on a cardiac ultrasound. ”

A pump that squeezes blood

Simply put, the heart is a pump that squeezes blood to flow throughout the body. Pumping power in healthy people does not usually decrease with age. But there are cases where it does. Westenbrink: “This can have all kinds of causes: from a scar that formed after a heart attack, due to genetic abnormalities, to toxins like alcohol.”

Since the 1940s, several medications for visible heart failure have been available that are prescribed to everyone. Additionally, there are pacemakers and other medical devices built into the body to support the heart. Westenbrink: ,, We have a great toolbox for these people to treat. Heart failure is still a dying disease. However, we were able to significantly reduce the chances of survival. Before half died after two years, now that point is reached at eight. But it’s still too short “.

As much experience cardiologists have with visible heart failure, they have so little experience with the invisible variant. Westenbrink: ,, When I was trained as a cardiologist for heart failure in Switzerland in 2015, I wasn’t even sure if invisible heart failure existed. Even ten years ago there were still cardiologists who openly doubted its existence. This is one of the reasons there is a huge knowledge gap. ”

As soon as they make an effort, they notice that it is difficult for them

The complaints of people suffering from invisible heart failure are not immediately recognized. Meems often sees older women in his surgery with complaints of fatigue. “They can no longer practice properly. When they sit in the chair at rest, they feel good. As soon as they make an effort, they notice that it is difficult for them. They complain that they can no longer vacuum their home continuously. They need to catch their breath in the meantime. Some have thick ankles. They have been doing it often for years ”.

Research by Meems and Westenbrink shows that many of these people have heart problems. Meems: ,, Their heart does not have reduced grip strength, but it does not draw enough blood. The heart stiffened, making it more difficult to fill with blood. Ultimately, it is of no use to a heart that can pump properly if there is no blood in it. Filling the heart is especially important during exercise, which explains why people feel good when they are standing still. ”

Meems has difficulty responding to the causes of invisible heart failure. “We think it’s a combination of multiple factors, such as age, high blood pressure, diabetes and obesity.”

It is also striking that it occurs more often in women. This is partly due to the fact that women, on average, are getting older. But that’s not all: Men often develop visible heart failure at a young age, while this form of heart failure often skips younger women.

From this year we can give them medicine

Two drugs are now available that can be prescribed to patients with invisible heart failure: the so-called SGLT2 inhibitors dapagliflozin and empagliflozin. These were once developed for the treatment of diabetes. Meems: ,, They proved less effective than expected for diabetes, but they protected diabetic patients from developing heart failure. Studies have shown that they could also mean a lot to people with visible and invisible heart failure. After ingestion, patients experience less discomfort, have less breathing and need to be hospitalized less often.

Westenbrink: ,, We were able to tell people that they had hidden heart failure. Then we got a diagnosis, but we couldn’t cure them. From this year we can give them medicine. This is an important step forward ”.

Drugs are now being prescribed all over the world. Westenbrink: ,, So we are not in front of the troops. These agents are internationally accepted to work. We also expect these to be reimbursed by the insurer within a few months, until then the treatments will be reimbursed by the manufacturer. ”

In the UMCG outpatient clinic, patients are examined with an exercise ultrasound and exercise cardiac catheterization, specialized techniques available only in a few hospitals in the Netherlands. Westenbrink: ,, What we offer is a certain diagnosis. ” Meems: ,, You either have it or you don’t. ”

The outpatient clinic is dependent on primary care physicians and regional hospitals who refer patients suspected of suffering from invisible heart failure. Westenbrink: ,, They make the first selection. If, after our investigation, it appears that this is indeed the case, patients will return to their cardiologist for a tailor-made treatment. ”

You can’t get rid of it

Invisible heart failure is a chronic disease. You can’t get rid of it anymore. The disease often goes hand in hand with other diseases such as anemia, impaired kidney function or lung disease. Meems: ,, Although you may die from invisible heart failure, we often see patients dying from the consequences of other diseases present. The quality of life of patients with invisible heart failure is lower. They have constant ailments such as shortness of breath and are often hospitalized ”.

Westenbrink would like to invite people who recognize the symptoms of invisible heart failure to contact their family doctor. ,, I think many older people with complaints adjust to the situation and think ach, night soez’n . I think they will benefit from the correct diagnosis and treatment, which is much better than ten years ago ”.