Behavioral and environmental factors contributing to the development and progression of congestive heart failure11The author wishes to thank Tim Furlong for excellent secretarial assistance in the preparation of this manuscript

Autor: Maria-Teresa Olivari
Rok vydání: 2000
Předmět:
Zdroj: The Journal of Heart and Lung Transplantation. 19:S12-S20
ISSN: 1053-2498
Popis: The incidence of heart failure continues to rise in western countries. The social and economic impact that congestive heart failure has on society is underscored by its prevalence, morbidity and mortality rates, lost wages, and cost for care. As the population ages and western standards of living are widely adopted by more countries, the incidence of congestive heart failure might reach, in the next few decades, epidemic levels. Coronary artery disease and hypertension remain the two most common causes for left ventricular systolic and diastolic dysfunction and chronic obstructive lung disease for isolated right ventricular failure in Europe and North America. In western countries the prevention of heart failure is based on effective primary prevention of coronary artery disease, lung disease, and on the concerted effort to timely and aggressively treat hyperlipidemia and hypertension, discontinue smoking, increase physical activity, and reduce obesity. Unfortunately while these risk factors have been widely publicized and should be well known to the general population, dramatic lifestyle changes have not yet occurred. In fact, recent discouraging reports indicate an increase in the incidence of obesity and cigarette smoking, and decrease in physical activity among adolescents.1 While primary prevention remains the ultimate goal, limitations of myocardial damage in patients with established coronary artery disease and prevention of the progression from asymptomatic left ventricular dysfunction to overt congestive heart failure may be more realistic and achievable goals. In patients with asymptomatic left ventricular dysfunction, in spite of improved medical management with ACE inhibitors and beta-blockers, clinical progression still occurs at a rate of 11%/year,2 suggesting that more aggressive and earlier treatment is needed and, in addition to hemodynamic and neurohormonal factors, other factors may play a role in the progression of left ventricular dysfunction. The contribution of behavioral and environmental factors to the development and progression of heart failure is underscored by the lower rate of progression of LV dysfunction and mortality in placebo-treated patients enrolled in multicentric trials in comparison to non-study CHF patients3,4 and by the analysis of factors which contribute to patients readmission rate. Among factors predictive of poor outcome are non-compliance, especially with salt restriction, alcohol intake, lack of social support, and poor medical education.5 Comprehensive management systems, which include counseling and supervised care, have been shown to decrease the rates of clinical decompensation and hospital admission, improve patients’ functional class and reduce cost of care.6–8 If such approach to the care of heart failure patients will ultimately improve their long-term prognosis remains to be ascertained. To our knowledge, very few studies have directly addressed the contribution of behavioral and environmental factors to the development of left ventricular dysfunction and congestive heart failure. Most of our knowledge is based on epidemiologic observations, such as the high prevalence of alcohol abuse and obesity among patients with heart failure. Behavioral and environmental factors which have been implicated in the development and/or progression of heart failure are listed in Table I. Their potential role depends on the underlying myocardial From the Minneapolis Heart Institute, Minneapolis, Minnesota. Submitted January 1, 1998; accepted September 27, 1999. Reprint requests: Maria-Teresa Olivari, MD, Minneapolis Heart Institute, 920 East 28 Street, Suite 300, Minneapolis, Minnesota 55407. Telephone: 612-863-3900. The author wishes to thank Tim Furlong for excellent secretarial assistance in the preparation of this manuscript. J Heart Lung Transplant 2000;19:12–20. Copyright © 2000 by the International Society for Heart and Lung Transplantation. 1053-2498/00/$–see front matter PII S1053-2498(99)00106-0
Databáze: OpenAIRE
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