Heart failure

What is heart failure?

Heart failure involves the impairment of the heart's pumping capacity. Exertion leads quickly to fatigue and shortage of breath.

Heart failure has several causes. The heart muscle gets weaker with age. The flow of blood to the heart muscle may be impaired or the muscle may be damaged by a heart attack. A chronic history of high blood pressure is the most common cause of heart failure in elderly people. ⁵²⁴
A leaking heart valve can also cause heart failure.

What are the complaints associated with heart failure?

The core symptoms are: shortness of breath, tightness of the chest, fatigue with minimal exertion and swelling in the lower legs (oedema).

Because the heart's pumping capacity is impaired, the flow of blood – and therefore of nutrients and oxygen – to organs and tissues is reduced. Fatigue and shortage of breath result. Fluid is retained and body weight therefore increases. The fluid accumulates in feet and ankles, causing them to swell. Fluid can also accumulate in the lungs. That leads to shortness of breath and tightness of the chest.

People with intellectual disabilities sometimes find it impossible to communicate these symptoms. The people around them may then notice only a change in behaviour.

How common is heart failure in the general population?

Heart failure is more common than it used to be owing to the ageing of the population and the improved survival rates of people with coronary heart disease. Prevalence rises sharply with age: from 0.8% between 55 and 64 years to 3% between 65 and 74 years, 10% between 75 and 84 years and 20% for people aged 85 and over. The age-corrected prevalence rate is higher in men than in women. More relatively young people with heart failure are men and coronary heart disease is the main cause. Because women live longer than men, there are more women with heart failure in the group aged 75 years and older.  ⁵²⁴  

The incidence of heart failure in the general population aged 50 and over is 4.3%.  ⁵²⁵

How common is heart failure in people with intellectual disabilities?

According to the Dutch GOUD study, the incidence of heart failure in people aged 50 years and over with intellectual disabilities is 12.5%.  ⁵²⁶

The underlying causes of heart failure (high blood pressure and heart attack) are as common as in the general population.  ^{526   527}

Other possible contributory factors to heart failure in older people with intellectual disabilities are congenital heart defects and extremely low levels of exercise.  ⁵²⁸

In the group of older people with intellectual disabilities, heart failure (in exacerbated form or new cases) was seen primarily in people with obesity around the waistline, people with chronic kidney disease and people with a prior history of heart failure. ⁵²⁶