Heart Failure (Cardiac Insufficiency): Prevention

To prevent heart failure (heart failure), attention must be paid to reducing individual risk factors. Behavioral risk factors

  • Diet
    • Consumption of “red” meat products (men); women over 50 years of age.
    • Low consumption of fruits and vegetables (women).
    • High intake of sodium and table salt
    • Micronutrient deficiency (vital substances) – see Prevention with micronutrients.
  • Consumption of stimulants
    • Alcohol (female: > 40 g/day; male: > 60 g/day) – up to 7 alcoholic drinks per week in early middle age was associated with a lower risk of future heart failure
    • Tobacco (smoking) – study using the principle of Mendelian randomization demonstrated that genetic propensity to use tobacco products was associated with an approximately 30% higher risk of heart failure compared with genetic abstinence from smoking (odds ratio, OR 1.28)
  • Physical activity
    • Physical inactivity
  • Psycho-social situation
    • Sleep duration – longer sleep had a favorable effect, shorter sleep had an unfavorable effect: staying in bed longer reduced the risk by about a quarter per additional hour of sleep (OR 0.73)
  • Overweight (BMI ≥ 25; obesity* * ).
    • Independent risk factor for diastolic heart failure with preserved systolic function (Heart failure with preserved ejection fraction, HFpEF); systolic heart failure as a direct consequence of obesity is rare.
    • In adolescents (life stage marking the transition from childhood to adulthood), risk already increased with BMI in the high-normal range; at 22.5-25.0 kg/m², risk increased by 22% (adjusted hazard ratio, HR: 1.22)

Medication

  • Non-steroidal anti-inflammatory drugs (NSAIDs; non steroidal anti- inflammatory drugs, NSAID).
    • 19% increased risk of decompensated heart failureA significantly higher risk was associated with current use of diclofenac, etoricoxib, ibuprofen, indomethacin, ketorolac, naproxen, nimesulide, piroxicam, rofecoxib
    • Nonselective NSAIDs: ibuprofen, naproxen, and diclofenac increased risk by 15%, 19%, and 21%, respectively
    • COX-2 inhibitors rofecoxib and etoricoxib led to a 34% and 55% increase in risk, respectively.
    • Very high doses of
    • Greatest hazard for heart failure-related hospitalization was associated with ketoralac (odds ratio, OR: 1.94)
  • Thiazolidinediones (glitazones) are not recommended in patients with heart failure because they increase the risk of heart failure exacerbation and heart failure-related hospitalization (III A)
  • Diltiazem and verapamil are not recommended in patients with HFrEF (“Heart Failure with reduced Ejection Fraction”; heart failure with reduced ejection fraction/ejection fraction) because they increase the risk of heart failure exacerbation and heart failure-related hospitalization (III C)
  • The addition of an angiotensin II receptor blocker (ARB) (or renin inhibitor) to combination therapy of an ACE-I and a mineral corticoid receptor antagonist (MRA) is not recommended in patients with heart failure because of the increased risk of renal dysfunction and hyperkalemia (III C)

Prevention factors (protective factors)

  • People who have normal blood pressure at age 45 or 55, are not obese, and do not have diabetes mellitus have a very low risk of developing heart failure in old age: risk reduction for men at age 45: 73%; women: 85%; onset of heart failure in men without the three risk factors: 34.7 years, in women 38 years; if only one of the three risk factors was present, heart failure occurred 3 to 15 years earlier.
  • Physical activity (one hour of moderate exercise per day) reduces the likelihood of heart failure by almost half

Recommendations for the prevention of heart failure according to the current S3 guideline:

  • Treatment of hypertension is recommended to prevent or delay the onset of heart failure and prolong life (I A)
  • Treatment with statins is recommended in patients who have CHD or are at high risk of CHD, regardless of the presence of LV systolic dysfunction, to prevent or delay the onset of heart failure and prolong life (I A)
  • Individuals who smoke or consume alcohol excessively are recommended to receive smoking cessation or alcohol reduction counseling and treatment to prevent or delay the onset of heart failure (I C)
  • An ACE-I is recommended in patients with asymptomatic LV systolic dysfunction and a history of myocardial infarction to prevent or delay the onset of heart failure and prolong life (I A)
  • An ACE-I is recommended in patients with asymptomatic LV systolic dysfunction without a history of myocardial infarction to prevent or delay the onset of heart failure (I B)
  • A beta-blocker is recommended in patients with asymptomatic LV systolic dysfunction and a history of myocardial infarction to prevent or delay the onset of heart failure and prolong life (I B)
  • ACE-I should be considered in patients with stable CAD, even if they do not have LV systolic dysfunction, to prevent or delay the onset of heart failure (IIa A)