Blood protein testing an important tool in tackling heart failure
Testing for the blood protein known as N-terminal pro B-type natriuretic peptide (NT-proBNP) can help patients with heart failure to enjoy a better quality of life while also reducing congestion in hospitals, a leading cardiologist has told The Nation.
Heart failure is a serious condition characterised by the heart's inability to pump enough blood to meet the needs of the body. This disease poses challenges in diagnosis as symptoms are often non-specific and, in the early stages, can even be silent.
During an interview with The Nation on Wednesday, Aekarach Ariyachaipanich, Heart Failure and Transplant Cardiologist at Chulalongkorn University's Excellence Centre for Organ Transplantation, said heart failure is among the diseases requiring hospitalization, adding that 20% of patients with this condition are readmitted to hospitals within 30 days of their discharge.
"Globally, an estimated 1% of the population suffers from heart failure and 10% of the elderly are victims of heart disease," he explained, adding that 20 of 100,000 hospitalised patients in Thailand are diagnosed with heart failure.
Some 50% of heart failure patients die within five years of being discharged from hospitals, he added.
Aekarach said heart failure is likely to intensify in Thailand partly because society is ageing but also due to poor lifestyle choices. Currently, hospitals are seeing heart failure in all age groups, children included. “Children develop heart failure due to genetic abnormalities and infection with heart-related viruses,” he explained.
He said people can recover from heart failure if they receive appropriate treatment and strictly follow physicians' recommendations. Only one-third of patients require a heart transplant.
NT-proBNP helps in diagnosis
The NT-proBNP approach helps physicians to diagnose heart failure patients effectively compared to echocardiograms (ECG) and exercise stress tests, which can take time.
"This diagnostic approach will be used for patients at risk of heart failure, including those who have diabetes, hypertension, and kidney disease, as well as those whose relatives suffered from heart failure or received cancer treatment," he said.
He confirmed that Thailand has both the knowledge and medication to treat patients with heart failure but advised health agencies to increase the number of heart failure experts and ensure that patients nationwide are able to access treatment quickly.
"Internal medicine physicians can treat heart failure patients, but they should send patients to expert cardiologists if they develop severe symptoms," he said.
Awareness and intensive care are important
Aekarach said awareness and intensive healthcare are important to enable heart failure patients to have a better quality of life and reduce congestion in hospitals.
He added that hospitals nationwide have set up key performance indicators to deal with heart failure, such as ensuring that patients receive all the necessary medications and avoid repeat hospitalisation.
Symptoms that indicate a risk of heart failure are:
• Unable to lie down for a long time
• Weight increase
• Swelling of the legs, abdomen, ankle and feet
He added that heart failure patients should exercise, albeit sensibly. “We ask heart failure patients to control their weight, avoid drinking alcohol and smoking, take their medication and consult the doctors periodically, he said.
Heart failure in the Asia-Pacific region
David Sim, director of the National Heart Centre's Heart Failure Programme and the Clinical and Translational Research Office in Singapore, said the number of patients suffering from cardiovascular disease increased by 23-35% over the period 1990 to 2019. Of these, 58% of patients or almost 3 billion had died, he added.
He said one of the most common types of cardiovascular disease is heart failure, adding that it triggered challenges in diagnosis, while also impacting economic and social aspects.
"The cost of heart failure hospitalisation in Asia-Pacific totals US$48 billion (1.65 trillion baht)," he said.
He pointed out that key gaps in heart failure diagnosis include:
• Lack of disease awareness among the public and primary care physicians
• Lack of diagnostic biomarker testing (blood testing)
• The variation in the availability of guideline-recommended medical therapy in healthcare institutions
• Lack of post-discharge and follow-up care
"NT-proBNP in the blood can tell whether patients are doing well or not," he said, adding that it is an effective way to give the best treatment to patients and reduce readmission.
He also urged related agencies in the Asia-Pacific region to create awareness about heart failure and include blood testing in treatment packages in a bid to improve people's quality of life.
Alexandre Mebazaa, professor of anesthesiology and critical care medicine at Hôpital Lariboisière in France, said patients who develop heart failure should be able to receive treatment quickly, similar to cancer patients.
He said the safety, tolerability and efficacy of rapid optimisation helped by NT-proBNP testing (Strong HF) has been designed to enable patients to access close follow-up treatment to prevent readmission and improve their quality of life.
He said the method, which features history-taking and blood testing, enables physicians to provide the best treatment to patients. He added that this approach is easily implemented and that a blood check is a safe and efficient way to diagnose heart failure, thus helping physicians to treat it effectively.