The diagnosis of heart failure is quite a “clinical challenge” in patients suffering from obesity, since its main symptom, which is intolerance to exertion, is usually attributed to obesity itself instead of heart failure.
The Spanish Society of Cardiology (SEC) and the Spanish Society of Endocrinology and Nutrition (SEEN) have come together to improve the approach to heart failure in people with obesity, which on March 4 commemorates its World Day.
Obesity is a highly prevalent disease, epidemic if possible, with a multifactorial cause and in some cases extremely complex since it is the cause of many complications, including cardiovascular ones, such as heart failure.
The main difficulty centers on the exertion intolerancethe main symptom of heart failure but which is also a consequence of obesity itself.
For an early diagnosis
The SEC and SEEN have produced a consensus document, “Detection and management of heart failure in obese patients”which includes a series of tips to guarantee a better and earlier diagnosis in cases of heart failure in people with obesity.
Thus, it is distinguished:
- What tests should be requested from the consultation of endocrinology ante suspicious symptoms and signs of heart failure.
- The global approach to risk factors.
- what initial treatment should be followed in these cases.
- Referral and coordination with cardiology to ensure the best patient care.
Ultimately, it is proposed multidisciplinary treatment of obesity to avoid the possible difficulties that derive from its symptomatology, somewhat generic.
The doctor Raquel Campuzano, one of the authors of the document and former president of the Association of Vascular Risk and Cardiac Rehabilitation of the SEC talks about the complications that obesity presents in this context.
“The diagnosis of heart failure in these cases, especially in the initial phases, constitutes a real clinical challenge because patients with obesity often have other comorbidities that make their diagnosis even more complex”, the expert points out.
Therefore, this proposal is nothing more than a new tool that the endocrinologist has to rrecognize, address, treat and refer to the patient, guaranteeing better care and, with it, a better prognosis. Because early treatment will always be an advantage in these cases.
What is heart failure?
The heart failure (HF) It occurs when the heart is not able to pump enough blood to the body. Its symptoms include:
- Dyspnoeathat is, shortness of breath due to cardiac causes.
- Difficulty exercising or regular physical activities.
The evolution of these symptoms and signs is a key element to reach a diagnosis, although it is necessary to carry out scans supplements to confirm.
Dr. Vicente Arrarte, member of the SEC and also author of the initiativeassures that in addition to intolerance to exertion, there are very characteristic symptoms when talking about heart failure, such as bendopnea (dyspnea when tying shoes) or orthopnea (dyspnea more evident when lying down).
Risk factor’s
Dr. Campuzano includes the main risk factors that increase the probability of heart failure in patients with obesity:
- Over 65 years.
- Presence of arterial hypertension.
- Diabetes mellitus.
- Chronic kidney disease.
- History of ischemic heart disease.
- atrial fibrillation.
Being over 65 years of age is a risk factor for heart failure. EFE/Kiyoshi OtaTools for its detection
As for the diagnostic tools used in these cases, they differ:
- Electrocardiogram: has an excellent predictive value to rule out heart failure.
- Measurement of plasma biomarkers.
- Echocardiography and other imaging techniques.
The problem of obesity in numbers
Given the prevalence of obesity, the risk of heart failure is an important factor to take into account.
And it is that according to Statistics National Institutethe incidence of obesity has doubled in the last 20 yearscalculating that one 17% of Spaniards are obese. A figure that is expected to continue to grow in the coming years.
Regarding the relationship between obesity and cardiovascular problems, some studies show that the risk of heart failure increases a 5% in men and 7% in the case of women for each point of increase in body mass index.
For this reason, from the SEC and the SEEN, multidisciplinarity and the importance of continuous improvement in medical care are advocated.