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Other Heart Disease - Heart Failure

Heart Failure

What is it?

Heart failure (HF) is a condition in which the heart’s ability to fill with or pump out blood is impaired.1 Heart failure does not mean that your heart has stopped or is about to stop working, just that it has become an inefficient pump. More than 5 million Americans are living with heart failure, including 2.6 million women.8 In 2004, nearly 60,000 people died from heart failure, and heart failure contributed to approximately 285,000 deaths (57% were women). Fewer than 15% of women with heart failure survive more than 8 to 12 years.9

Heart failure develops gradually over time, and can be caused by many diseases or conditions that damage or overwork the heart muscle. The leading causes of heart failure are coronary artery disease, high blood pressure, and diabetes.

The main symptoms of heart failure are shortness of breath, fatigue, swelling of the ankles, feet, legs and sometimes the belly, and fluid buildup in or around the lungs.1 These symptoms are often mistaken for signs of aging. For this reason, many women may not become aware of their condition until years after their heart begins its decline.

For more information, see our main article on Heart Failure.

How is it related to stroke?

Like many other cardiovascular diseases, heart failure and stroke are linked because they share many risk factors (such as high blood pressure and diabetes) and they both occur more often in people who have atherosclerosis, or hardening of the arteries.

However, heart failure also has more direct effects on stroke risk. When the heart can’t pump as efficiently, blood tends to sit still longer than normal inside the heart and the blood vessels of the arms and legs.10 This stagnant blood is more likely to form a clot, which can then travel to the brain, causing a stroke or TIA.

How does it affect my stroke risk?

Patients with heart failure have an above-average risk of stroke. One community-based study of 630 people (54% were women) found that men and women with heart failure were 17 times more likely to have stroke than the general population in the first 30 days of being diagnosed, and were still at increased stroke risk 5 years later. Almost 2% of heart failure patients will suffer a stroke within the first year after diagnosis, and nearly 5% will within 5 years.11

The more severe your heart failure is, the higher your risk of stroke: in one study, each 5% decrease in ejection fraction (the percentage of blood in the heart that is pumped out each beat) caused an 18% increase in the risk of stroke.12 There is no evidence of differences between men and women in the amount of stroke risk associated with heart failure.

What can I do to prevent stroke?

If you have heart failure it’s important to make lifestyle changes and take the medications your doctor prescribes to relieve your symptoms and treat the causes of your heart failure. These therapies have the added benefit of reducing your chances of dying of cardiovascular disease and stroke.

The lifestyle changes typically recommended for heart failure patients include following a low-salt diet like the DASH diet. This prevents the buildup of extra fluid in the body that can make heart failure worse, but it also helps lower blood pressure, a major risk factor for stroke. Blood pressure-lowering medications such as B-blockers, diuretics, and ACE inhibitors also help reduce your blood pressure and therefore your stroke risk. Other lifestyle changes for heart failure, such as losing weight and exercising, also beneficially affect not only your chances of survival, but also your stroke risk profile.

Some heart failure patients may also receive anticoagulants to reduce the risk of a stroke caused by a blood clot. This may be particularly useful in women with heart failure and atrial fibrillation, who are at especially high risk for stroke. However, it is not clear how to identify which heart failure patients, if any, benefit from anticoagulant medication to reduce stroke risk.10

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