Heart failure refers to various structural or functional abnormalities of the heart that result in a heart muscle that cannot pump enough blood. Approximately 6.7 million adults in the United States have heart failure, and one in four people will develop heart failure within their lifetime. Recent research, including a report from the Heart Failure Society of America and a research letter in JAMA Cardiology, has shown that heart failure incidence, prevalence, and mortality are rising in younger adults.
In the following Q&A, Michael Beasley, MD, assistant professor (cardiovascular medicine), discusses these trends, symptoms of heart failure, and the importance of early intervention.
1. What do we know about trends in heart failure rates among younger adults?
It’s important to know that heart failure is predominantly a disease of older adults. The absolute number of people who have heart failure is much higher in older adults.
However, research has shown that the relative incidence and prevalence of heart failure are becoming more common in younger adults under the age of 65, especially among people who identify as Black or Hispanic.
This concerning trend is happening while we are seeing declines in the overall incidence and prevalence of heart failure among older adults due to better treatments and care delivery.
2. What are the symptoms of heart failure in younger adults?
Patients with heart failure often have a circulatory system impairment caused by structural or functional cardiac abnormalities. This impairment causes fluid retention and congestion that leads to a variety of symptoms, such as shortness of breath and lower extremity edema (swelling in the lower legs) or abdominal distension.
3. Some of the symptoms you mentioned, like shortness of breath and abdominal distension, might be easy for a younger person to overlook.
Absolutely. Also, because younger people are often more physiologically fit, they can often tolerate these abnormalities more than older adults. As a result, their symptoms may be more subtle at first, and they may not show the same severity of signs or symptoms that an older person with the same level of disease would.
Younger people are also much less likely to have primary care physicians or regular checkups with a healthcare provider. As a result, it often means patients are not diagnosed until the abnormality of their heart function has progressed to cause a significant impairment in circulation. They then come to the emergency department and require significant inpatient care before long-term outpatient management.
4. What interventions are available to younger adult patients with heart failure?
When younger patients come to the hospital with heart failure, we often first stabilize them with a simple diuretic therapy delivered either through an IV or orally, depending on the severity of the symptoms. These diuretics relieve the congestion and help patients feel better, but they don’t fix the underlying problem.
To repair the heart, we use a combination of disease-modifying drugs. These are long-term treatments that the patients need to stay on, or else their heart will get weak again. Currently, there are four classes of drugs that should be started as quickly as possible. Any delay allows for an increase in mortality or morbidity risk.
In the past, physicians were less aggressive with treatments. Now we know it’s essential to move quickly and aggressively to get patients up to guideline-recommended levels. Research shows that it’s safe to do so, and it saves lives.
5. Is there anything people can do to prevent heart failure?
In some cases, yes. Heart failure prevention is focused on living a heart-healthy lifestyle. This includes eating a diet high in fruits and vegetables, avoiding red meats, quitting tobacco use, and getting adequate physical activity.
However, other types of heart failure have nothing to do with lifestyle. Many patients, especially those who are younger, have congenital or inherited causes of heart failure.
6. What are the congenital or inherited causes of heart failure?
Congenital heart disease outcomes are improving in the pediatric population, allowing a lot more young people with congenital heart disease to live into adulthood. But, by definition, patients with congenital heart disease have a structural abnormality of their heart, so they often end up developing heart failure.
The other group of people have inherited cardiomyopathies – a genetic predisposition to developing heart failure. One type is hypertrophic cardiomyopathy, where the heart muscle gets thick and stiff but still causes impairment of the circulatory system.
However, even among those with a genetic predisposition to disease, some people develop more severe forms of the disease than others. We’re still learning about how environmental factors, social determinants of health, and other factors affect gene expression and impact the prevalence or severity of the disease.
7. What should other clinicians know about heart disease in younger people?
I would encourage all clinicians to keep a broad differential diagnosis when seeing somebody with new-onset shortness of breath. When younger patients see a primary care physician or urgent care center and report shortness of breath, their clinicians may misdiagnose them with asthma or a respiratory infection rather than heart failure. Even if a patient is young, heart failure may still be the correct diagnosis.
Early detection of heart failure is critical so that patients can begin treatments to modify the disease. It's the best way for us to improve outcomes and reverse this trend.
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