Healthy Aging Beats Heart Failure

By Michael Hodin

It might be a coincidence that the Gerontological Society of America’s (GSA) 2019 Annual Scientific Meeting and the American Heart Association’s (AHA) Scientific Sessions are both taking place this week, welcoming thousands of the most preeminent global experts in their respective fields. But the overlap of these constituencies’ interest in heart failure is no coincidence, as both recognize the 21st-century reality that the vast majority of people with heart failure are over the age of 50.

It’s also no coincidence that the new Global Alliance on Heart Failure and Healthy Aging launches this week. This bold, innovative new effort is set to engage both the CVD and aging communities to underscore the fact that heart failure becomes far more difficult to diagnose, treat, and manage once we reach age 70. In light of this fact, we must seize critical, but long overlooked, opportunities to better address this disease and its enormous health and economic costs, as part of healthy aging.

In the United States alone, projections show that the prevalence of heart failure will increase 46% between 2012 and 2030. Age is a principal risk factor for heart failure, as over 80% of patients are 65 years old or older in Europe and North America. This was underscored by the most recent JAMA Cardiology report and Wall Street Journal headline, “Deaths from heart failure, one of the nation’s biggest killers, are surging as the population ages.” However, paradoxically and sadly, age is also a critical reason why, to-date, treatment and awareness remain low, even as prevalence rises dramatically — an ever-widening gap.

What is not well understood is that this progressive condition is America’s eighth leading cause of death and a contributing factor in more than half of all heart disease deaths. Because of this lack of understanding, heart failure continues to be under-recognized and under-diagnosed, often only first noticed in hospital emergency care, far later than it should be. Heart failure results in more than 1 million hospitalizations annually in both the United States and Europe; many of which could be prevented, if we stopped confusing the early symptoms with normal parts of aging. In fact, heart failure is the most common reason for hospital admission in people over 65 years of age across OECD countries. If people and providers better understood heart failure, its symptoms, and who’s at risk, we could prevent these hospitalizations, readmissions, and unnecessary reduction in quality of life, as well as explosions in costs.

The connection between age and heart failure — and the gap between fully understanding the two –is the principal driver for the creation the Global Alliance on Heart Failure and Healthy Aging. One of its key goals will be to fight the effect of widespread ageism in this area. Consider a story from a senior business leaders at the Silver Economy Forum this past July, when the Global Coalition on Aging and the Finnish Government, in its capacity leading the Presidency of the Council of the European Union, convened business and government leaders from around the world to discuss a wide range of topics including cardiovascular disease. Perhaps one of the most memorable and enduring moments was this description of how ageism profoundly influences the prospects for healthy and active aging, itself a precondition to make the Silver Economy a reality. A senior business leader focused not on the data or details of the science, but on the real-life impact. He described how, in a recent conversation with his 80-something mother, she confided that she had been experiencing weariness, fatigue, and dizziness. As a son, he encouraged her to tell her doctor about what very well may be early indicators of heart failure. She averred without hesitation, as if she too had succumbed to her fate: “No, my doctor will say that I’m just getting old.”

This anecdote exemplifies the ageism — from the healthcare system and from all of us, young and old alike — that leads to missed or late diagnosis of heart failure, particularly in the 50+ category, as well as the hospitalization and hospital readmissions that might very well be avoided. Treatment pathways and specialized care do exist, but they can’t be effective if we don’t get to a diagnosis early enough. This is why more than 30 expert organizations from across sectors, disciplines, and geographies have come together in agreement on the following seven principles as the basis of the new Alliance:

1. Heart failure is not given adequate attention as a health priority because it is not well understood by those most affected or at risk, especially those in the 50+ age demographic.
2. Early symptoms of heart failure such as shortness of breath, swelling, rapid weight gain, and fatigue are often wrongly dismissed as normal parts of the aging process or misdiagnosed as other co-morbidities associated with aging.
3. Important stakeholders in the monitoring, detection, and treatment of heart failure, including healthcare professionals and caregivers outside the CVD community and the medical field, sometimes lack the education and information needed to ensure that people with heart failure receive evidence-based care according to applicable clinical guidelines, and that their non-medical needs — including social, emotional, and financial support — are adequately met.
4. More research, communication, and advocacy activities are required to understand the potential future clinical and socioeconomic impact of heart failure on health systems as societies continue to age, and to ensure that policy makers understand and act upon the available evidence regarding this impact.
5. Heart failure — and failure to recognize it early and treat it appropriately — results in high hospitalization and readmission rates and cost burdens, which can be alleviated with better and more evidence-based care and treatment.
6. Heart failure with preserved ejection fraction (HFpEF), which is rapidly growing in prevalence among the oldest segment of the general population and in women in particular, is an area of particular unmet need since it currently lacks any approved pharmacologic treatment.
7. All stakeholders affected by heart failure — including physicians, nurses, clinic and hospital administrators, policy makers, caregivers, and patients themselves — will benefit from greater exposure to global best practices in preventing, detecting, diagnosing, and treating heart failure, and — for patients — living one’s best life following diagnosis.

The Alliance will focus on actions to stimulate education, awareness, policy changes, and improved practices relating to this widely misunderstood, insufficiently recognized, and increasingly burdensome and costly disease, taking actions to:

1. Unravel the myth that heart failure is a normal consequence of aging.

2. Ensure healthcare professionals and older people themselves take symptoms of heart failure seriously to address it earlier and mitigate its negative effects.

3. Increase uptake of guideline recommendations that improve heart failure outcomes.

4. Coordinate heart failure care, especially interactions between primary care (where heart failure care should be centered and co-morbidities managed) and specialists.

5. Smooth care transitions, especially between institutional care and home, to decrease risks of repeated hospitalizations.

So, as the global public health community prepares for the Decade of Healthy Ageing to be declared at the May 2020 World Health Assembly, the attention to heart failure and aging is especially welcome. Moreover, global, national, and community leaders focused on financial and fiscal sustainability will also want to connect the dots of our current missed opportunity around the myths and misunderstanding of heart failure and aging. Projections suggest that, by 2030, the total cost of the disease will increase by 127% to $69.8 billion in the US, alone— not least connected to the link between population longevity growth and heart failure. We can and must bend the curve on that straight-line analysis. If the Global Alliance on Heart Failure and Healthy Aging can link healthy aging to economic growth, it will serve us all.