Heart Failure Management in Developing Countries

Abstract

Heart failure (HF) is a considerable global health concern plaguing high-income countries and low- and middle-income countries. Heart failure is allied with substantial increased morbidity, mortality, poor quality of life, and a significant economic burden on national healthcare systems. The number of patients with heart failure has been rapidly increasing to an estimated 26 million patients worldwide. Heart failure is the end-stage manifestation of most forms of heart disease. Consequently, traditional risk factors play an important role in the genesis of HF as they do for many other manifestations of heart disease. The role of coronary disease is likely progressing, reflecting the evolving epidemiology of coronary disease. The association between coronary disease and heart failure was conceptually thought to be primarily mediated by the occurrence of large myocardial infarctions, leading to sizable ventricular scarring and remodeling, both harbingers of overt clinical heart failure. Raised atrial pressure is common in HF and predisposes to atrial fibrillation, the onset of which can result in the development of acute heart failure. Many patients with heart failure have at least moderate renal impairment. Many patients with moderate to severe heart failure develop anemia of chronic disease and/or functional iron deficiency. Severe heart failure can cause a general loss of fat, lean and bony tissue, associated with a particularly poor prognosis. In heart failure there is loss of bulk, impaired intrinsic perfusion, increased fatigue, and underlying abnormal histology and metabolism of skeletal muscle. Around 50% of patients with advanced heart failure suffer from sleep disordered breathing. Obstructive sleep apnea, caused by loss of pharyngeal muscle tone, is common, but central sleep apnea becomes predominant in patients with more severe failure. Heart failure is evolving rapidly as a global epidemic. Twice as many deaths due to heart failure are now seen in developing countries as compared to developed countries. Until then, the currently available treatments for the management of acute and chronic heart failure, along with the recent recommendations, ought to be considered in developing countries.