A number of heart-related health conditions can contribute to CHF. They include coronary artery disease, high blood pressure, cardiac arrhythmia, or a previous heart attack.
This article explains the factors that may affect outcomes for people who are living with CHF. It talks about steps you can take to reduce some of the risk factors that can lead to poor outcomes.
Overall Survival
CHF is a chronic and progressive condition. It weakens the heart, which then is unable to pump enough blood. It limits the heart’s ability to deliver the oxygen and nutrients needed for the cells in your body to function.
There are two main types of heart failure. The first is heart failure with reduced ejection fraction, also known as systolic heart failure. In this case, the heart muscle itself is weak and cannot adequately pump blood to the rest of the body.
The second main type is called heart failure with preserved ejection fraction, or diastolic heart failure. Here, the heart muscle is stiff rather than weak. This makes it hard for the heart to fill with blood.
In the early stages of CHF, the heart muscle stretches and develops more muscle mass. These changes allow it to contract (squeeze) with more force to pump more blood. But over time, the heart enlarges. It can no longer manage its workload. This will lead to symptoms that include:
FatigueShortness of breathIncreased heart rateSwelling (edema) in the legs
CHF is broken down into four stages. They range from an initial high risk of developing heart failure to advanced heart failure. As the symptoms get worse, so does the stage of CHF.
The prognosis for CHF is based on five-year mortality (death) rates. This measure is used to estimate short- and long-term survival rates from the time that your CHF is diagnosed and treatment begins.
A review published in 2017 looked at people with CHF. It included people who were treated in the community and those seen by a healthcare provider as outpatients. The study found the average CHF survival rates were:
80-90% after one year, compared to 97% in the general population50-60% by the fifth year, compared to 85% in the general population30% by year 10, compared to 75% in the general population
Prognosis by Stage
Prognosis depends on the stage and cause of CHF, as well as a person’s age, sex, and socioeconomic status. Stages of CHF range from A to D.
Stage A: High risk for heart failure, but without symptoms or structural heart diseaseStage B: Structural heart disease, but without signs or symptoms of heart failure (also known as pre-heart failure)Stage C: Structural heart disease with prior or current symptoms of heart failureStage D: Advanced heart failure characterized by recurrent hospitalizations despite attempts to optimize treatment
The table below shows five-year mortality data for each of the four stages of CHF.
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Age
Heart failure typically affects older adults (middle-age and older). Among Medicare patients, it is the leading cause for hospitalization. Complications of CHF also rise steadily with age.
One clinical trial looked at hospitalization rates for different age groups, from age 20 through age 65 and older. It found the death rates were lower for patients in the 20-44 age group. They were less likely to be admitted to the emergency room or hospitalized for heart failure or other cardiac issues.
However, death rates were still significant for people younger than 44 after 30 days (3.9%), one year (12.4%), and five years (27.7%). The study found that serious CHF episodes were more frequent in half of the people who were readmitted to the hospital. Two-thirds of them went to emergency rooms, and more than 10% died within a year.
Sex
Women with CHF tend to live longer than men when the cause isn’t ischemia, an inadequate blood supply to the heart muscles. In fact, women with this type of heart failure have a better chance of surviving than men, either with or without heart disease as their main cause of heart failure.
Other health issues that affect survival in women with heart failure, especially after menopause, include:
High blood pressureHeart valve conditionsDiabetesCoronary artery disease
Once coronary heart disease has been diagnosed, the risk of CHF increases.
Exercise Tolerance
CHF symptoms include labored breathing and fatigue. Low exercise tolerance also is a key symptom in CHF. It is associated with poor quality of life and an increased mortality rate.
Exercise intolerance means there is a reduced and limited amount of oxygen that a person can use during an intense workout. It also means that you have a limited ability to carry out any physical activity. The capacity of your heart and lungs are key contributors.
Other factors, such as anemia, obesity, and any muscle or bone disorders, also play a role in your overall exercise tolerance.
The three-year survival rate for people living with CHF who have a reduced exercise tolerance is 57%. This compares with 93% in those with normal exercise tolerance.
Ejection Fraction
The heart has four chambers: the right atrium and ventricle, and the left atrium and ventricle. The left ventricle forces blood out into the body. Ejection fraction measures the percentage of blood that is pumped out by the left ventricle each time the heart contracts.
The quality of this function is used to classify different types of heart failure. If the ejection fraction is normal, this is called heart failure with preserved ejection fraction. If the ejection fraction is diminished, this is called heart failure with reduced ejection fraction.
Preserved ejection fraction (HFpEF), or diastolic heart failure: The heart contracts normally but the ventricles do not relax as the ventricle fills with blood. Reduced ejection fraction (HFrEF), or systolic heart failure: The heart does not contract properly. This leads to less oxygen-rich blood being pumped out to the body.
Normal ejection fraction rates range between 50% and 70%. Function is considered borderline when it falls between 41% and 49%. This doesn’t always mean that a person is developing heart failure, but it may be a sign of heart damage or a prior heart attack. An ejection fraction rate of 40% or lower may indicate heart failure or cardiomyopathy.
Death rates for people with diastolic heart failure are lower compared to people who have systolic heart failure. One study, with a mean follow-up of 37 months, showed the mortality rate increased in proportion to any decrease in left ventricular ejection fraction (LVEF). The results were:
LVEF under 15%: mortality - 51% LVEF 16-25%: mortality - 41. 7%LVEF 26-35% : mortality - 31. 4% LVEF 35-45%: mortality - 25. 6%
Diabetes
Type 2 diabetes is a factor that increases the risk of poor outcomes in people with CHF. About 20% to 40% of heart failure patients have diabetes. At least 10% of high-risk heart patients may have diabetes that has gone undetected and not been diagnosed.
A study of 400 people looked at the number of diabetes and acute heart failure cases among them. The group of 203 men and 197 women had an average age of 71 years. Among them were 37% who had known diabetes, 16% with undiagnosed diabetes, and 47% who did not have it.
The people with diabetes were more likely to have certain other health issues, including:
Hypertension (high blood pressure) Dyslipidemia (high cholesterol) Peripheral vascular disease Previous heart attack
People in the group with undiagnosed diabetes were similar to those without diabetes, in terms of these related health conditions. However, people with diabetes and undiagnosed diabetes had more hospital stays due to acute heart failure in the prior year. This was true even with no differences in their left ventricular ejection fractions. Yet the incidence of heart failure with systolic dysfunction (an ejection fraction of less than 40%) was similar in all three groups.
Patients with undiagnosed diabetes were 1.69 times more likely to die than those without diabetes. Patients with undiagnosed diabetes showed fewer heart-related risks than the people with diabetes, but the death rates were similar between the two groups.
Hospitalization
Heart failure relapses that require hospitalization often point to poor outcomes. The symptoms associated with these episodes also suggest that failure is progressing. The 30 days after a first hospitalization are seen as a high-risk period. Intense follow-up and monitoring are needed.
What You Can Do
Some risk factors of heart failure, like age, can’t be modified. Still, people with CHF can take steps to improve the long-term prognosis. The first thing to do is to be familiar with any family history of heart disease. You’ll also want to learn about all the possible symptoms. Don’t ignore any symptom that you think is cause for concern. Tell your healthcare provider about them right away.
Regular exercise, along with managing any other health issues you may have, can also help to keep CHF under control.
Exercise
If you are diagnosed with heart disease, then weight loss alone does not lower your mortality risk. Yet ongoing and sustained physical activity is associated with some risk reduction.
Another study looked at patients with diabetes who were hospitalized for heart failure. Of those patients, 65% were overweight or obese and 3% were underweight. People who were diabetic and underweight had a 50% chance of dying within five years.
The odds of dying were lower by 20% to 40% for those with obesity than for patients at normal weights. This finding may seem odd, but it can be explained by the age of the obese patients. They were younger than people in the other weight groups in this study.
Diabetes Control
Diabetes has been linked to the risk of heart failure. Among people with diabetes, 25% have chronic heart failure and up to 40% have acute heart failure. For this reason, people with both diabetes and heart failure are treated by cardiologists (heart specialists). To reduce the risk of death, good blood sugar control is key.
Angiotensin-converting enzyme (or ACE) inhibitors are often used to help treat both type 1 and type 2 diabetes with heart failure. ACE inhibitors offer a number of benefits, and are linked with a lower death rate and fewer hospitalizations. Angiotensin II receptor blockers, or ARBs, have shown similar benefits in heart failure patients with and without diabetes.
Medications
In heart failure with reduced ejection fraction, a few drugs have been shown to reduce deaths and hospitalizations. Healthcare providers may prescribe the following medications in some combination:
Beta-blockers (carvedilol, metoprolol succinate, or bisoprolol) Entresto (sacubitril with valsartan) An ARB or ACE inhibitor Spironolactone Sodium glucose co-transporter 2 (SGLT2) inhibitors Ivabradine
In heart failure with preserved ejection fraction, no medications have been shown to improve mortality except diuretics. There is some evidence that spironolactone may also offer a benefit.
Summary
The left ventricle is the chamber of the heart that forces blood out into the body. When it no longer works properly, the amount of blood it forces out into the body is not adequate for its needs.
This can happen because the heart muscle is too weak, causing what’s called a reduced ejection fraction. It also can happen due to the muscle becoming stiff and unable to relax, as is the case with preserved ejection fraction.
These fractions are used to measure how well your heart is working. Along with other factors, such as age or additional health problems, they contribute to an assessment of how serious or advanced your CHF has become. This helps healthcare providers to offer you the most accurate estimates possible when it comes to your disease progression and your life expectancy.
A Word From Verywell
The prognosis for CHF may seem discouraging, but there are lifestyle changes and medications that can help. They can slow down CHF progression and boost your chances of survival. You can be proactive by monitoring your symptoms and putting unhealthy habits aside. Regular exercise and a healthy diet can help.
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