Overview
Heart failure (HF), a condition in which the heart is unable to pump blood to the muscles and organs at an adequate rate, affects approximately 5,000,000 people in the US, and more than half a million new cases are diagnosed per year.2 In 2003, more than 57,000 people died of HF, and it was an underlying or contributing cause of death in approximately 287,000.2 The most common causes of HF are104:
- CAD
- Hypertension
- Valvular heart disease
The risk for HF increases as people age,2 and it is the leading cause of hospitalization for patients aged 65 years and older.105 At age 40, the lifetime risk of HF is106:
- 1 in 5 for both men and women overall
- 50% higher for women (1 in 6) than for men (1 in 9) without antecedent MI
HF in Women
HF is common among women with CAD.107 Approximately 46% of women who have an MI will be disabled with HF within 6 years (compared with 22% of men).108
The HERS and HERS II* studies identified 9 risk factors that were independently associated with the development of HF in women with established CAD107:
- Diabetes
- Atrial fibrillation
- Myocardial infarction
- Renal insufficiency
- Hypertension
- Obesity
- Current smoking
- Left bundle-branch block
- Left-ventricular hypertrophy
Diagnostic Issues
Early diagnosis is essential for successfully treating the underlying causes, but initial diagnosis of HF can be difficult.104 False diagnoses are common.109,110 Diagnosis may be even more difficult in women than in men.109,110 In one study, 73% of false-positive diagnoses occurred in women.110
A systematic approach has been recommended to improve diagnostic accuracy for HF:
- Complete clinical history to assess for signs/symptoms and risk factors of HF.104,111
- Thorough physical examination, including cardiovascular, venous, pulmonary, hepatic, and extremity assessments.104,111
- Assessment of the patient's ability to perform routine/desired activities.111 Exercise intolerance is inextricably linked to the diagnosis or HF.112
- Laboratory workup for various disease markers.104,111,113
- Diagnostic testing.104,111,113
- Electrocardiography, chest radiography, and echocardiography are the primary recommended diagnostic tests for the initial assessment of HF.104,111,113
- Noninvasive stress imaging (eg, nuclear imaging or echocardiography) should be considered for patients with known CAD or a high probability of CAD and no angina (except those who are not candidates for revascularization).104,111,113
- Reduced exercise capacity is a clinical hallmark of HF, likely the result of dyspnea and fatigue - the primary symptoms of HF.111, 112, 114 This can limit patients' ability to exercise for stress testing.
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Diabetes
Obesity
Metabolic Syndrome
Race/Ethnicity
Defining Risk in Women
Exercise Capacity in Women
C-Reactive Protein
Atrial Fibrillation
Heart Failure
Fat Distribution and Heart Disease in Women
Fitness Levels
Rheumatoid Arthritis
Aging
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