【Common Diseases】Heart Failure

A must-read guide to heart failure treatment for Hong Kong residents

Heart failure does not mean the heart has "stopped" or "completely failed." Rather, it refers to a compromised pumping function, making it unable to effectively pump enough blood to the body to meet its needs. It is a chronic, progressive disease that is very common among the elderly and those with cardiovascular disease in Hong Kong.

According to data from the Hong Kong Hospital Authority, heart failure is one of the leading causes of hospitalization in Hong Kong, with high readmission and mortality rates within one year of hospitalization. As someone who has long focused on cardiovascular health, I've noticed that many people have a vague impression of heart failure, believing it's simply a "natural condition of old age." However, it's actually the terminal stage of many diseases, requiring active treatment and long-term management.

1. What is heart failure?

Heart failure can be classified as:

  • Systolic heart failure (HFrEF) : weakened heart contractility and reduced ejection fraction (EF)
  • Diastolic heart failure (HFpEF) : Impaired cardiac relaxation, with normal contractility but insufficient ventricular filling.
  • Acute heart failure : sudden worsening of the condition, requiring urgent treatment

2. Causes

Common causes of heart failure in Hong Kong include:

  1. Coronary heart disease and myocardial infarction – damage to heart muscle tissue
  2. High blood pressure – long-term increase in heart burden
  3. Valvular heart disease – aortic stenosis, mitral regurgitation, etc.
  4. Arrhythmia – chronically fast or slow heartbeats
  5. Cardiomyopathy – congenital or acquired causes
  6. Diabetes – damages blood vessels and myocardial function

💡 Editor's observation: Poor control of the "three highs" (high blood pressure, high blood sugar, and high cholesterol) in Hong Kong is one of the main drivers of heart failure.

3. Symptoms

  • Difficulty breathing (when moving or lying down)
  • Ankle and calf edema
  • Easily tired and weak
  • Frequent waking up to urinate during the night
  • Rapid weight gain in a short period of time (due to edema)

4. Why is treatment needed?

If heart failure is not treated, it can gradually worsen and cause:

  • Severe activity limitation
  • Frequent hospitalizations
  • Arrhythmia and sudden death
  • Organ ischemia (kidney, brain)

In Hong Kong, the prognosis for heart failure patients cannot be ignored, with some data showing that their survival rate is similar to that of certain cancers.

5. Treatment Goals

  1. Relieve symptoms (shortness of breath, edema)
  2. Improve quality of life
  3. Reduce hospitalizations
  4. Extend life

6. Treatment

Treatment includes three major directions: lifestyle improvement , drug therapy , device assistance or surgery .

6.1 Lifestyle Improvement

  1. salt-restricted diet

    • Recommended daily sodium intake is ≤ 2 grams (approximately 5 grams of salt)
    • Reduce processed foods, soup bases, and salty snacks

  2. Limit fluid intake (on doctor's advice)

    • This is especially important for patients with severe edema or hyponatremia

  3. Monitor your weight regularly

    • Weigh yourself at the same time every morning. If your weight increases by > 2 kg in a short period of time, be alert to worsening edema.

  4. moderate exercise

    • Cardiac rehabilitation exercises (such as brisk walking and light stretching) after doctor's evaluation

  5. Avoid excessive drinking and quit smoking

    • Alcohol damages the myocardium, and smoking accelerates vascular hardening.

💡 Editor's Tip: Noodle soups and barbecued rice in Hong Kong tea restaurants are high in sodium. Heart failure patients are advised to choose menus with less soup, skin removed, and less sauce.

6.2 Drug treatment

Commonly used medicines in Hong Kong hospitals include:

  1. ACE inhibitors (ACEIs)

    • Such as Enalapril, Lisinopril
    • Dilate blood vessels, reduce heart burden, and prolong life

  2. ARB (angiotensin II receptor blocker)

    • Such as Losartan, Valsartan
    • Suitable for patients who cannot tolerate ACEI

  3. ARNI (angiotensin receptor-neprilysin inhibitor)

    • Such as Sacubitril/Valsartan
    • A new generation of drugs that are more effective than ACEI (more common in private healthcare)

  4. Beta-blockers

    • Such as Bisoprolol, Metoprolol
    • Slow down the heartbeat and protect the myocardium

  5. diuretics

    • Such as Furosemide
    • Reduces edema and shortness of breath but does not improve prognosis

  6. MRA (aldosterone antagonist)

    • Spironolactone
    • Reduce hospitalizations and improve survival

  7. SGLT2 inhibitors

    • Such as Dapagliflozin
    • Originally used for diabetes, it has recently been shown to be beneficial for heart failure

💡 Editor's observation: Hong Kong public hospitals give priority to using ACEI, beta-blockers, and MRA as basic treatment. ARNI and SGLT2 inhibitors are more common in private healthcare, but the cost is higher.

6.3 Instrumental and surgical treatment

  1. Implantable cardioverter-defibrillator (ICD)

    • Preventing sudden death from high-risk arrhythmias

  2. Cardiac resynchronization therapy (CRT)

    • Improve ventricular coordinated contraction and increase blood pumping efficiency

  3. LVAD

    • As a transition to heart transplant or long-term support for terminally ill patients

  4. Heart transplantation

    • Suitable for terminally ill patients who have failed to respond to medication or other treatments (Hong Kong has a paired transplant program, but donated hearts are scarce)

7. Hong Kong’s medical resources

  • Cardiology and Internal Medicine Departments in Public Hospitals : Provide comprehensive examinations, medications, and device treatments. Costs are low, but waiting times are long.
  • Private cardiology : Faster examinations and new drug options, but higher costs
  • Community cardiac rehabilitation programs : Some non-profit organizations collaborate with hospitals to provide exercise training and dietary guidance

Editor's summary

Although heart failure is a chronic disease, it is not uncontrollable. Through a salt-restricted diet, medication, cardiac rehabilitation exercises , and, when necessary, advanced medical devices or surgery, patients can significantly improve their quality of life and prolong their lives. In Hong Kong, the challenge lies in the long waiting times for public healthcare and the high costs of private treatment. Therefore, early prevention and control of hypertension, diabetes, and coronary heart disease are the best strategies to avoid the development of heart failure.

Disclaimer : This article is for reference only and does not constitute any medical advice. The source is referenced from major medical articles.

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