Heart Failure in Diabetes: What Nashville Patients Need to Know
My name is William Conway, MD. I am a Nashville concierge physician who has spent my career caring for patients who want a concierge physician. Concierge means a physician who is available, discrete, and attentive. I am a physician who anticipates your needs, who you can always call, and you can trust. I am here for you over the years, without a bureaucracy separating us. I practice both internal medicine and addiction medicine through Suboxone+Primary Care™ and Nashville Concierge Medicines. My approach to you is simple. I listen to you. I am your steady partner. You have easy, direct access to me. I constantly study medicine to serve you better.
Executive Summary
- Patients with Diabetes have a much higher risk for heart failure- often two to four times higher than others.
- HF is a very common chronic illness which touches many families in Nashville.
- HF is a serious – its five-year survival can be similar to cancer or chronic lung disease.
- Typical symptoms are fatigue, or shortness of breath, and swelling (edema)
The Case Study
John is a fifty-year-old plumber in Nashville who has worked hard to support his family for three decades, often working sixty hours per week. He is proud of his work ethic. He and his wife raised their daughter in a home they built together.
About three months ago, John noticed a deep tiredness that would not lift. His energy faded. Workdays he once handled easily became exhausting. He is now unable to work sixty hours per week . His ankles are swelling. He finds himself short of breath at work if he exerts too much. He is no longer able to mow the grass in his off time. John has to calculate now to get the workday. He carefully depends upon his assistant to do the heavy work.
John has always been healthy. He is large, carrying more weight than what he should, Years ago, he was told that “his sugar was borderline.” John felt well at that time and elected to ignore being “borderline. His blood pressure has always run slightly high at 145/90. John has never been in the hospital before.
When I saw John in the office at Nashville Concierge Medicine, I diagnosed him as Heart Failure. Over the next three years until John’s death, I walked with him through that journey. Together, we worked to find comfort, strength, and understanding.
Why Heart Failure? How Common ?
Heart Failure is common.
- Heart failure is sadly common in our region.
- A Nashville Health survey reported 4 % of adults in Davidson County had heart failure.
- 12% of patients enrolled in Medicare have heart failure.
- Heart Failure remains the number one diagnosis for Medicare, both in total admission and total cost
- 40% of patients with heart failure also have diabetes.
Heart Failure is the most common heart disease in diabetes. This means that many of our neighbors living with diabetes are quietly at risk. In Nashville Concierge Medicine, I, Dr. Conway, see it frequently-patients who heart failure grew slowly and silently over the years.
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How Serious is Heart Failure
John was healthy, active, and having a good life until the onset of Heart Failure at age 50. Three years later, at age 53, John died from Heart Failure. Heart Failure can and often does have a progressive downhill course. Each year after diagnosis, a significant number of people die. At the end of five years, approximately 80 percent of patients have died. These numbers are sobering. They remind us why prevention and early treatment matter
How Serious is Heart Failure in comparison to Cancer or Chronic Obstructive Pulmonary Disease
Heart failure is not mild. It is every bit as serious as cancer or advanced lung disease. When John was first diagnosed, we could not exactly know how much time he had, but we knew his life expectancy was shortened. That awareness changed how he lived=he began to focus on what mattered most, like time with his wife and daughter.
Doctors often talk about healthspan-the number of years you live with energy, clarity, and comfort. Ideally, our lifespan and healthspan match: we stay active and engaged right up the very end. A long life filled with struggle and pain is very different from a long life lived with vitality. My goal with every patient is to close that gap-to help you stay strong, present, and connected for as many years as possible.
Healthspan means how many good years of life do you have. Ideally, you prefer to have a life span and healthspan which are identical. This means that on the day of your death, you are active, out of bed, enjoying the beauty of day, with minimal discomfort. Life which is longer with suffering is different than life without suffering.
Let’s look at how John’s health span has changed and what lessons it offers for all of us.
What is Heart Failure?
Heart failure simply means that the heart is no longer pumping blood as efficiently as it once did. The body feels this through fatigue-the heart cannot keep up with what your muscles and body needs. As the pressure builds, fluid can back up into the lungs, making ti breathing harder and rest less refreshing.
Diabetes can independently lead to heart failure over time. And the “companions” that often come with diabetes-high blood pressure, high cholesterol, smoking, and coronary artery disease-all add stress. If you live with diabetes, protecting your heart should be one of your main goals. Heart failure is, in fact, the most common form of heart disease linked to diabetes. Prevention is essential.
Causes of Heart Failure in Diabetes
Heart Failure is complicated. There are many cause which work for years silently before you become sick. John was obese, which placed long term stress on his heart. John had high blood pressure, which placed long term stress on his heart. John smoked, which also placed long term stress on his heart. John had untreated diabetes for years, which placed long term stress on his heart.
Heart failure develops slowly, often after years of quiet wear on the heart. John’s story is familiar: Extra weight, high blood pressure, smoking, and untreated diabetes all work together to weaken his heart. Each risk factor adds- over time, they work their damange.
When John was thirty, these same risks could have been turned around. With treatment, wight loss, blood pressure control, and quitting smoking. The body forgives a great deal when we make changes early. This is quiet power of prevention
When John was thirty, he could have had treatment for his diabetes, his blood pressure, his cholesterol, and his weight. John could have stopped smoking.
Signs and Symptoms Nashville Patients Should Never Ignore
Too Much Extra Fluid in Body, especially the Lungs
- Shortness of breath on mild exertion
- Swelling of legs or ankles
- Weight gain of more than 2–3 pounds overnight
Heart failure usually announces itself in small ways first-small enough that people like John often overlook them. But catching them early can save your strength and years of health.
At the beginning of his illness, when John first knew that he was sick, his ankles swelled. He required an extra pillow at night to keep sleeping. He became short of breath when walking at a gentle pace. John no longer had the carefree free life that he previously had. I cared for John in my office in Concierge Medicine in Nashville. In the first year of his illness, we worked together to manage fluid, adjust his medications, and help him find a rhythm that let him keep working and enjoying small joys. I, Dr. Conway, find our visits meaningful.
Advanced Symptoms
- Waking at night gasping for air
- Difficulty lying flat without extra pillows
- Abdominal swelling or decreased appetite
As his illness progressed, John felt weaker and sicker. On occasion, he would awake in the middle of night, desperately short of breath, with labored breathing, feeling as though he was drowning. John’s trip to the emergency room became more frequent. His hospitalizations became more frequent. John’s life became more limited, his movements slower, and his wife’s support more important.
How is Heart Failure Diagnosed
Simple Office and Lab Tools
- BNP blood test: checks for heart strain
- Echocardiogram: ultrasound to see heart’s pumping ability
- EKG: detects rhythm changes
Common Findings
- Enlarged heart, fluid in lungs, or reduced ejection fraction
Most of these tests ae quick and painless.
The Risk of HF in Diabetes
For people with diabetes, the risk or heart failure climbs sharply with age. Studies show that it can be 30% to 130% higher than in those without diabetes. In one published example for a 60-year-old woman, diabetes raised the 10-year heart failure risk from about 1.7% to 7.9%. The message is clear: early care, good blood pressure control, and steady follow-up make an enormous difference.
Summary: CTA
Call Nashville Concierge Medicine for Dr. Conway at 615-708-0390
