Cardiovascular diseases represent a significant health challenge in India, with heart failure being a prominent condition among them. According to a recent report by the Asian Pacific Society of Cardiology (APSC), heart failure accounts for 1.8 million hospitalisations annually in India. This condition places a substantial burden on the healthcare system and affects both men and women, though the prevalence and outcomes can vary between genders. In particular, men tend to be diagnosed with heart failure at a younger age compared to women, who often present with more advanced stages of the disease due to different risk factors and biological differences. Addressing heart failure in India requires targeted strategies to manage its impact across different demographics, emphasizing the need for gender-specific approaches in treatment and prevention.
Understanding heart failure
Understanding heart failure is crucial, as it is a complex condition where the heart is unable to pump blood efficiently, leading to inadequate circulation and oxygenation of the body’s tissues. This syndrome can result from various underlying issues such as coronary artery disease, hypertension, diabetes, and cardiomyopathy. Heart failure manifests in symptoms like shortness of breath, fatigue, swollen extremities, rapid heartbeat, persistent cough or wheezing, increased need to urinate at night, swelling of the abdomen, rapid weight gain from fluid retention, and difficulty concentrating or decreased alertness. The condition is categorised into types based on which part of the heart is affected: left-sided, right-sided, or congestive heart failure. Treatment typically involves a combination of lifestyle changes, medications, and sometimes surgical interventions, tailored to manage symptoms and improve quality of life.
Differences between
men and women
While the underlying causes and basic symptoms of heart failure are largely similar between men and women, there are notable differences in how they experience and manage the disease. Men tend to be diagnosed with heart failure at a younger age and often have more severe symptoms at the time of the time of diagnosis. In contrast, women are typically diagnosed later in life, with the onset of heart failure often linked to the decline in protective oestrogen levels post-menopause. Men are more likely to report classic symptoms such as chest pain and shortness of breath, whereas women often experience non-classic symptoms like fatigue, nausea, and abdominal swelling. Women may also have a higher incidence of heart failure with preserved ejection fraction (HFpEF), where the heart contracts normally but the ventricles do not relax properly. Risk factors also vary, with men facing higher risks due to lifestyle factors like smoking, alcohol consumption, and hypertension. For women, the risk increases significantly post-menopause due to hormonal changes, and conditions like diabetes and high blood pressure pose greater risks compared to men. These gender-specific differences highlight the need for tailored approaches in the diagnosis and management of heart failure (World Heart Federation, BioMed Central).
Who is more at risk?
Determining the comparative risk of heart failure between men and women is complex, as it depends upon factors such as age, lifestyle choices, and underlying health conditions. Generally, men face a heightened risk at a younger age due to a higher prevalence of risk factors such as smoking, alcohol consumption, and hypertension, which contribute to earlier onset and more severe manifestations of heart disease. In contrast, women typically develop heart failure later in life, yet their prognosis may be bleaker. This is attributed to the presence of co-existing conditions like diabetes and hypertension, compounded by the loss of oestrogen’s protective effects.
Management and treatment
Medications:
• ACE Inhibitors and ARBs: Help relax blood vessels and reduce the workload on the heart
• Beta-blockers: Slow the heart rate and lower blood pressure, reducing strain on the heart
• Diuretics: Help reduce fluid buildup in the body, alleviating swelling and shortness of breath
• Aldosterone Antagonists: Prevent fluid retention and improve heart function
• Digitalis: Strengthens heart contractions and helps manage arrhythmias
Lifestyle Changes
• Diet: Low-sodium, heart-healthy diets rich in fruits, vegetables, and whole grains
• Exercise: Regular, moderate physical activity tailored to individual capabilities
• Smoking Cessation: Eliminating tobacco use to improve heart and overall health
• Alcohol Reduction: Limiting alcohol intake to prevent further heart damage
• Weight Management: Maintaining a healthy weight to reduce strain on the heart
Medical devices and surgery
• Implantable Cardioverter-Defibrillators (ICDs): Help prevent sudden cardiac arrest
• Pacemakers: Regulate heartbeats in patients with arrhythmias
• Ventricular Assist Devices (VADs): Mechanical pumps that support heart function
• Heart Transplant: For severe cases where other treatments have failed
