Have you been overweight for years? Do you suffer from atrial fibrillation? Is your problem high blood pressure that you can’t control? Tell me how your heart failure arises and I’ll tell you how to cure yourself and above all what your health will be over the years. In the future, perhaps the cardiologist will propose a series of algorithms to those dealing with heart failure that, case by case and based on the mechanism that created the “tired heart”, will define the treatment path to be implemented and the prospects .
All thanks to programs developed by Artificial Intelligence (AI) systems. Already today, even if we are only at the beginning of a journey, AI can inform about the future prospects of those suffering from heart failure, starting from the conditions that gave rise to the picture. This reality, paving the way for tailored treatments based on the expected prognosis for each patient, is defined by research conducted by experts at University College London, published in Lancet Digital Health.
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More or less serious forms of decompensation
The research, coordinated by Amitava Banerjeelooked at information on more than 300,000 people age 30 and older who received a diagnosis of heart failure over 20 years of observation. Then, thanks to specific AI algorithms, they developed five different “identikits” that allow for the analysis of the main causes of heart failure. In particular, it has been seen that there may be early-onset, late-onset cases related to atrial fibrillationtherefore to the more frequent form of arrhythmia, to a problem of a metabolic nature but with a reduced cardiovascular impact and with real cardiometabolic pictures, in which obesity was also linked to the presence of disease affecting treatments and arteries.
Analyzing all this data, the experts were able to define a real ranking on the severity of the heart failure, with a consequent impact on the prognosis based on the type of mechanism that gave rise to the heart weakness.
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The survey, which also considered the genetic information relating to a population of just under 10,000 people to evaluate the presence of a polygenic risk scale under this aspect as well, clearly showed that the form of decompensation directly linked to atrial fibrillation is the hardest to manage.
The risk of all-cause mortality one year after diagnosis in this form was 61%. People with late-onset forms of “tired heart” (46%) and with more serious cardiometabolic problems (37%). Less frightening, perhaps because they are more controllable, were, on the other hand, early-onset decompensations and those of a metabolic nature, linked only to severe overweight and obesity without metabolic problems.
From the results of the research and the available data, the London scholars have developed an app capable of determining which subtype a person with heart failure has, in order to develop personalized treatments and doctor-patient relationships. “Currently, how the disease progresses is difficult to predict for individual patients,” Banerjee said. Some people will be stable for many years, while others will deteriorate rapidly. According to experts, better distinguishing between the different types of decompensation could allow for more targeted treatments for each patient.
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What happens in case of decompensation
Heart failure is a condition that occurs when the muscle tissue of the heart is damaged and overworked, often as a result of high blood pressure, atherosclerosis, arrhythmias, or heart valve disease. Obviously it can have different severity and therefore the treatments must also be studied on a case-by-case basis. In general terms, the condition relates to the reduced ability of the heart to relax, because the muscle has become stiffer. The blood then has difficulty entering the atria and ventricles, so the excess fluid accumulates in different parts of the body.
The disease impairs arterial and venous circulation, resulting in fatigue for cardiac performance. In fact, the damaged heart is unable to pump blood efficiently enough to maintain arterial circulation. The amount of blood that is pumped from the heart to the body is therefore reduced, while that which returns from the body to the heart through the veins meets with increased resistance. This is why the liquid tends to come out of the blood vessels and can create both pulmonary edema, in the most serious forms, and swelling of the feet and ankles.
The most common symptoms are the dyspneai.e. difficulty breathing, often after minimal effort, le palpitations because the heart increases its rate to compensate for any deficit, the strong tiredness and cough.
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