Heart failure (HF) is a heterogeneous syndrome, with progressive evolution and negative impact on quality of life and mortality of patients. The incidence of HF in Europe and the United States of America varies between 1 to 9 cases per 1000 inhabitants, depending on the population studied and the diagnostic criteria used(1). Currently, it is estimated that approximately 64.3 million people suffer from HF world-wide(2).
One of the most important therapeutic goals for patients with HF is represented by maintaining and improving the quality of life. Many patients value functional status and quality of life more than longevity. The most important predictors of the quality of life in HF are the presence of symptoms and their severity, functional status and depression(3). Current guidelines recommend the combined use of medical and behavioural interventions to improve the functional status of these patients(3). Treatment with angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, beta blockers or mineralocorticoid receptor antagonists have proven to be effective in reducing hospitalization rates or mortality rates, but not in improving physical performance among patients with HF(4). However, the use of spironolactone seems to have promising results in HF with preserved ejection fraction (HFpEF)(4). Among the therapeutic agents with a favourable impact on the quality of life in HF patients are ivabradine, sacubitril/valsartan or dapagliflozin(4). Aerobic exercise training proved to be safe and effective in improving the physical performance of both patients with HFpEF and those with HF with reduced ejection fraction (HFrEF)(4). Future research will have to determine the long-term effectiveness of these exercises. Other data from specialized literature with convincing evidence regarding the improvement of effort capacity in patients with this disease are iron supplementation in case of iron deficiency and the use of anabolic drugs, such as testosterone, in selected categories of patients(4). The prevalence of iron deficiency in patients with HF is approximately 50%(5). Many of these patients have iron deficiency, but without developing anaemia. The European Society of Cardiology guideline recommends screening for iron deficiency by measuring serum ferritin and sideremia in all patients with HF(4). If iron deficiency is identified, intravenous iron supplementation is recommended, as oral supplementation is not as effective in restoring iron deposits(4). Skeletal muscle atrophy has also a significant negative impact on the effort capacity of patients with HF. Research on improving skeletal muscle mass and function is limited and suggests the usefulness of anabolic substances like testosterone(4). The treatment of comorbidities such as diabetes, chronic kidney disease, sleep-disordered breathing or depression has proven essential in establishing efficient therapeutic management to improve the quality of life of patients with HF(4).
In conclusion, HF is a public health problem because the number of patients living with this condition is increasing, reflecting both the chronic evolution of the disease and the aging process of the population. Maintaining and improving the functional capacity of the patient with HF should become a major target in the therapeutic management, to reduce the global disease burden.
Address for correspondence:
Camelia C. DIACONU