High Tech Care for Heart Failure Patients: A Bathroom Scale

Heart failure is a term that virtually everyone has heard of, but many people don’t truly understand what heart failure really means for patients and their families. More than 6 million Americans suffer from this common condition. The disease often requires repeated, urgent medical care, and heart failure is the No. 1 cause of hospitalizations in patients 65 years and older. Heart failure is both a common contributor and often a relatively fast cause of death: heart failure plays a role in greater than 10 percent of deaths in the U.S., and about one half of heart failure patients die within five years of being diagnosed with the condition (meaning that the likelihood of dying from heart failure is greater than dying from cancer within five years of first being diagnosed).

So, just what is heart failure? The heart is a pump with two sides, each side having an upper pump chamber and a lower pump chamber. The left side receives freshly oxygenated blood returning from your lungs and then pumps that bright red blood throughout your body. The right side receives oxygen-depleted blood from your body’s veins and then pumps that blood to the lungs. Thus, your blood travels in a relative circle through arteries and back to the heart through veins via this circulatory system, with the heart as its sole pump. Simple plumbing. But in heart failure, the pump no longer works at full capacity; that is, the heart pump fails to adequately push blood throughout the body. This pump failure can be caused by a number of diseases, such as coronary artery disease, high blood pressure, and diabetes, but the result is the same: a heart that cannot adequately pump blood at the rate required by the body.

Even a tiny decrease in blood flow sets off alarms throughout your body, as cells desperately need fresh oxygen and nutrients to be delivered and carbon dioxide and waste products to be removed via the bloodstream. One of the body’s major responses to even slightly diminished blood flow is the triggering of a system of hormones, which tells the kidneys to hold on to more salt (from you diet), which subsequently results in your body also holding on to more water (also from your diet). Your body is wired to increase your blood flow back to normal by keeping more water in your blood vessels (as opposed to releasing that water in your urine), a response that has evolved to reduced blood flow caused by dehydration or blood loss (injury). But unfortunately, holding on to and dumping even more water into the circulatory system does not help and often worsens the function of the failing heart. And unlike the pipes in your house, fluid readily leaks out of the blood vessels if the heart pump is failing. The fluid causes swelling as it fills the tissues of the feet, ankles, legs, and lungs. Fluid leakage into the lungs (pulmonary edema) causes terrifying shortness of breath and represents an acute life-threatening condition.

If you suffer from heart failure, you live on a roller coaster. You do doing pretty well for a couple of months but then notice that your ankles seem a little swollen. It’s a minor annoyance for the next week or so. But then suddenly one evening you become severely short of breath. Just like that, it’s hard to get enough air. Your terrified spouse calls for an ambulance. You arrive at the ER where they immediately place an oxygen mask over your face and give you medicines to get the fluid out of your lungs and to support your failing heart. You’re admitted to the hospital, maybe even the Intensive Care Unit, and you eventually begin to feel better. Fortunately, you’re on your way home in six or eight days. But sometimes you’re in the hospital for much longer. And one time, you fear, you will never go home.

That’s the typical heart failure roller coaster, and it’s awful for patients, family members, and physicians. But if you or a loved one suffers from heart failure, there are things that you can do to smooth out that roller coaster ride, to reduce the number of ER visits and middle-of-the-night hospital admissions, to limit those terrifying episodes where every breath is suddenly a struggle.

And none of these things that you can do to help yourself are high tech.

First, strictly follow your doctor’s instructions for medications and diet. But then there is an additional low tech, high value activity that you can do to greatly help yourself.

Weigh yourself. Every day. Every day at the same time. Every day at the same time wearing the same thing (or nothing at all). For example, first thing every morning, weigh yourself in your bathrobe before you eat or drink anything. And write down the date and your weight. Why? Early worsening heart failure is often so subtle that you have little or no symptoms. However, your body detects even subtle worsening heart failure and immediately responds by holding on to more fluids (again, this your kidneys attempting to increase vital blood flow). While you are unaware that your kidneys are suddenly retaining fluid, that fluid has weight. A gallon of water weighs more than 8 pounds. Thus, every additional quarter of a gallon of water that your kidneys retain equates to a 2 pound weight gain that you might not notice unless you see it staring back at you from your bathroom scale. And long before you suddenly begin gasping for breath (often more than a month before), your body is holding on to pound after pound of extra fluid. The week before patients need emergent hospitalization, their weight gain accelerates even faster.

Clinical studies demonstrate that recognizing weight gain early on (before serious symptoms like shortness of breath develop) allows patients to receive outpatient medical intervention (medications) and potentially avoid emergency room visits and hospitalizations. Work with your physician to understand just what weight gain over a day or a few days should trigger a call to your doctor’s office.

You can reduce those ER visits and middle-of-the-night hospitalizations simply by Owning Your Health and accepting responsibility for keeping a close eye on your struggling heart.

All it takes is a commitment from you. And a bathroom scale.