Congestive Heart Failure - Prognosis

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What is the long term prognosis for patients with congestive heart failure?

Congestive heart failure is generally a progressive disease with periods of stability punctuated by episodic clinical exacerbations. The course of the disease in any given individual, however, is extremely variable. Factors involved in determining the long term outlook (prognosis) for a given patient include:

  • the nature of the underlying heart disease,
  • the response to medications,
  • the degree to which other organ systems are involved and the severity of other accompanying conditions,
  • the person's symptoms and degree of impairment, and
  • other factors that remain poorly understood.

With the availability of newer drugs to potentially favorably affect the progression of disease, the prognosis in congestive heart failure is generally more favorable than that observed just 10 years ago. In some cases, especially when the heart muscle dysfunction has recently developed, a significant spontaneous improvement is not uncommonly observed, even to the point where heart function becomes normal.

Heart failure is often graded on a scale of I to IV based on the patient's ability to function.

  1. Class I is patients with a weakened heart but without limitation or symptoms.
  2. Class II is only limitation at heavier workloads.
  3. Class III is limitation at everyday activity.
  4. Class IV is severe symptoms at rest or with any degree of effort.

The prognosis of heart failure patients is very closely associated with the functional class.

An important issue in congestive heart failure is the risk of heart rhythm disturbances (arrhythmias). Of those deaths that occur in individuals with congestive heart failure, approximately 50% are related to progressive heart failure. Importantly, the other half are thought to be related to serious arrhythmias. A major advance has been the finding that nonsurgical placement of automatic implantable cardioverter/defibrillators (AICD) in individuals with severe congestive heart failure (defined by an ejection fraction below 30% to 35%) can significantly improve survival, and has become the standard of care in most such individuals.

In some people with severe heart failure and certain ECG abnormalities, the left and right side of the heart don't beat in rhythm, and inserting a device called a biventricular pacer can significantly reduce symptoms.

Return to Congestive Heart Failure

See what others are saying

Comment from: Tiffany, 45-54 Female (Patient) Published: October 18

I had been experiencing a lot of shortness of breath and all my doctor would say is that I was overweight so I just ignored the problem for a very long time. The problem worsened so I finally switched doctors and he had me admitted into the hospital and a right heart catheterization was performed, this showed that I had what is called diastolic heart failure, which is a form of congestive heart failure (CHF). My condition worsened and now I am in CHF, I have a lot of swelling in my legs, and I am extremely short of breath and weak. I am on 14 pills a day for this condition and it basically helps me get through the day. I still work a full-time job which is unphysical; I sit at a desk all day because I wouldn't have the energy to do anything physical.

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Comment from: Neen, 45-54 Female (Patient) Published: January 27

I was released from the hospital this past Tuesday after almost a week of being in the hospital with the diagnosis of CHF. I had shortness of breath for a long time, swelling in feet which I attributed to just gaining water weight as a woman thing and other symptoms that mimicked panic attacks. They did EKG's among other tests and while in hospital, had a heart catheter done too. The results revealed no blockage. Thank goodness but my heart is weakened as a result. I fortunately left the hospital getting my breath back and no longer suffer from shortness of breath. I have to follow up with a cardiac doc and maintain a strict 2000 mg sodium diet as well as taking blood pressure med and vitamins. I also have to weigh myself everyday too. I will now do whatever it takes to get my health back. I never want to fight to just walk a few feet without feeling dizzy or out of breath ever again.

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