Heart Failure and Life Expectancy

If you learn that you have heart failure, don’t let the name fool you. Your heart has not failed. On the contrary, you are suffering from a disease in which your heart has difficulty pumping oxygen-rich blood to the rest of your body.

“This can lead to backing up fluid in the lungs and congestion in the lungs, causing shortness of breath, chest pain and fatigue, as well as backing up fluid elsewhere in the body,” says Brent Lampert, DO, cardiologist. at the Wexner Medical Center at Ohio State University in Columbus.

Depending on the severity of your heart failure, you may notice swelling in the ankles and legs. Your heart may beat faster than usual, or its rhythm may not be as regular. Your stomach may swell and you may lose your appetite.

It’s a serious diagnosis. But doctors have learned a lot about how to treat heart failure with careful care, often including a prescription drug combination that relieves symptoms the most.

And life expectancy is increasing: around half of those diagnosed today can expect to live at least 5 years longer, up from 41% in 2000, according to a study.

Special calculators provide an estimate of your life expectancy with heart failure. With an online tool, the Seattle Heart Failure Model, you can insert your lab’s results and the type of treatment you are receiving to project your odds.

But keep in mind that these calculators are based on large groups of people and may not include the latest research, says Gregg Fonarow, MD, a cardiologist who runs the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles.

“Even the most accurate risk models will not be enough for most people,” Fonarow says. “The best thing to do is talk to your doctor, who can help you interpret all of your risk factors, rather than trying to figure out your risk on your own.”

What determines life expectancy?

There are things that affect your life expectancy with heart failure that are beyond your control, such as your age. Others, like a healthy lifestyle, are not.

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Things that can affect life expectancy include:

The ejection fraction. To get a better idea of ​​the health of your heart, your doctor will check how well an area of ​​your heart called the left ventricle is pumping blood. An echocardiogram is a test that is often used. It scans the heart and takes measurements to find out what percentage of your blood is pumped with each heartbeat. For example, an ejection fraction of 55% means that 55% of your blood is expelled with each stroke. A normal result is usually between 50% and 70%, according to the American Heart Association.

People with reduced ejection fraction have one type of condition. This is called heart failure with reduced left ventricular function. With the other type, heart failure with preserved left ventricular function, the percentage is not lower than normal. But there are other changes, like the stiffness of the heart. “Once the heart squeezes and pumps blood forward, it has to relax to fill with blood,” Lampert says. “When the heart muscle is stiff or unable to relax because the blood tries to rush and fill it, it is not very compliant, and so you can get the same results of returning fluid to the lungs and other parts of the body. “

If your heart failure involves a reduced ejection fraction, your doctor will monitor this number closely. If it drops too low, to 35% or less, you have a higher risk of a potentially fatal heartbeat.

Staging. There are four stages of heart failure, which indicate the severity of your condition.

  • Stage A: You do not have complete heart failure, but you have certain risk factors. You may have a family member with heart failure. Or you may have other medical conditions, such as high blood pressure, alcohol abuse, diabetes, or heart disease.
  • Stage B: Tests show your heart has been damaged, but you don’t notice any symptoms. Most likely, you had a lower than normal heart function test result. Most people with stage B have an ejection fraction of 40% or less.
  • Stage C: You have symptoms that can come and go, such as fatigue. You may be less able to exercise, have swollen or weak legs, or have shortness of breath.
  • Stage D: Your symptoms are more severe and do not improve with drugs and other treatments.

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Choice of lifestyle. There are things you can do today to improve the quality of your life and possibly extend it, says Lampert. Smokers should try to quit and he advises avoiding alcohol. “I generally advise people to avoid it.”

Stay as active as possible under a doctor’s direction or with a heart program, Lampert says. Follow the recommendations for limiting sodium and the amount of fluids you drink.

Even these small dietary steps can have a big impact, says Lampert.

“One factor associated with a shorter lifespan is recurrent hospitalizations,” he says. “Every time you are hospitalized, your life expectancy gets shorter. If you can control fluids and sodium and stay out of the hospital, it can definitely improve the quality and quantity of life. “

Track medications. It might seem obvious, but Lampert and Fonarow both stress the importance of not skipping your meds. You will probably need to take more than one medicine for your heart failure. They can have side effects and their effectiveness may change as your condition progresses.

“When you do develop symptoms, report them and stay in close contact with your doctor,” Lampert says. “So if you start to get worse, they can act quickly.”

The good news is that recent research shows that taking a combination of heart failure drugs helps extend the life expectancy of people with reduced ejection fraction, Fonarow says. In one study, the drug combination improved survival by an average of 6 years across all age groups.

“There has been a significant and critical revolution in our ability to diagnose and treat patients with heart failure,” Fonarow says. “Because it’s not a single drug on its own, but it’s this combination, it hasn’t received the attention it rightly deserves.

Sources

SOURCES:

Cleveland Clinic: “Heart Failure: Understanding Heart Failure.”

Brent Lampert, DO, cardiologist, Wexner Medical Center at Ohio State University, Columbus.

BMJ: “Trends in survival after a diagnosis of heart failure in the UK 2000-2017: a population-based cohort study.”

Gregg Fonarow, MD, director, Ahmanson-UCLA Cardiomyopathy Center, Los Angeles.

Cleveland Clinic: “Echocardiogram”.

American Heart Association: “Measuring Heart Failure Ejection Fraction”.

Lancet: “Estimated Lifetime Benefits of Comprehensive Pharmacologic Disease Modification Therapies in Patients with Heart Failure with Reduced Ejection Fraction: A Comparative Analysis of Three Randomized Controlled Trials.”


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