Heart failure with preserved ejection fraction life expectancy

Congestive heart failure is a chronic, progressive condition that affects heart function. It can be life-threatening if left untreated.

Congestive heart failure (CHF), or simply heart failure, affects the heart’s ability to pump blood around the body. Despite its name, CHF does not mean that the heart has failed completely.

A person’s life expectancy with CHF will vary depending on numerous factors including their age, the stage of their condition, and the strength of their heart function.

Many disorders that weaken the heart can contribute to the development of CHF, including:

• heart attacks
• coronary heart disease
• congenital heart disease
• faulty heart valves
• high blood pressure
• inflammation or damage to the heart muscle
• Drug or toxin use.

However, in some cases, a person’s life expectancy can be extended through lifestyle changes, medications, and surgery.

Life expectancy with CHF may be nonlinear and dependent on several variables. A review highlighted that many physicians do not feel they can confidently predict a patient’s clinical trajectory in a 6-month time frame.

A 2019 meta‐analysis estimated that the 1-, 2-, 5-, and 10‐year survival rates of all-type heart failure are 87%, 73%, 57%, and 35%, respectively, although life expectancy for a person with CHF has substantially improved over time.

A person’s age at diagnosis may impact prognosis. Authors reported that 5-year survival rate for people under 65 was around 78%, while the rate was 49% for those 75 and over.

Additionally, the strength at which a person’s heart pumps blood out per beat, its ejection fraction, may affect life expectancy. Doctors will note a patient’s ejection fraction as a percentage, with a normal output falling between 50-70%.

Patients with an ejection fraction of under 40% may be at greater risk of dying from CHF. However, a 2017 study reported that 5-year life expectancy was poor among all patients admitted to hospital with heart failure regardless of ejection fraction, and estimated 5-year mortality to be 75.4%. The above 2019 meta-analysis also found no significant difference in survival rate between patients with an ejection fraction below 40% and those with one above.

The presence of underlying conditions, or comorbidities, such as coronary heart disease, can affect a person’s life expectancy. An age-adjusted study found that comorbidities were common in heart failure patients and contributed to higher death rates. Diabetes was present in 28% of deaths and chronic obstructive pulmonary disease in 16%.

Risk factors, such as obesity, hypertension, and a poor diet may also negatively impact outlook.

CHF is not curable, but early detection and treatment may help improve a person’s life expectancy. Following a treatment plan that includes lifestyle changes may help improve their quality of life.

In a person with CHF the muscles of the heart may become too stiff, or too weak to pump blood efficiently. This causes the blood to stay in the ventricle rather than pushing it out. The blood remaining in the heart can cause fluid retention.

Doctors will often assess a patient’s functional capacity on the New York Heart Association’s classification system. The classes are:

• Class 1: A person has no limitation on their physical activity and no adverse symptoms.
• Class 2: There is a slight limitation on physical activity, but the person is comfortable at rest.
• Class 3: A person has a notable limitation on physical activity but remains comfortable at rest.
• Class 4: A person cannot engage in physical activity without discomfort and experiences symptoms of heart failure at rest.

A second classification system , defined by the American College of Cardiology and American Heart Association, details four stages of heart disease. They are:

• Stage A: A person has a high risk of heart failure but currently has no identifiable disorders.
• Stage B: A person has a structural heart disorder but is not presenting symptoms.
• Stage C: A person has current or prior symptoms of heart failure associated with an underlying condition.
• Stage D: A person currently has advanced structural heart disease, shows clear symptoms, and requires specialized medical intervention.

Common symptoms of heart disease include:

• swelling in the legs and feet or weight gain caused by a buildup of excess fluid
• bloating
• shortness of breath or waking up at night short of breath
• Inability to lie flat or needing to sleep on extra pillows.
• fatigue
• nausea
• chest pain

Other conditions that affect the heart can also cause CHF. Early diagnosis of CHF may help people manage their symptoms and make preventative lifestyle changes.

Medical treatment for CHF may involve treatments to reduce the amount of fluid in the body. This may ease some of the strain on the heart and improve its ability to pump blood. Doctors may prescribe diuretics to help the body eliminate excess liquid. Common diuretics include hydrochlorothiazide, bumetanide, and furosemide.

Doctors may also prescribe angiotensin-converting enzyme (ACE) inhibitors, angiotensin receptor blockers (ARBs), or angiotensin receptor blocker neprilysin inhibitors (ARNIs) to help the heart pump blood more effectively.

These treatments may reduce morbidity in patients with reduced left ventricle output, according to reviews .

Other key components of CHF therapy include mineralocorticoid receptor blockers (MRAs) and sodium-glucose co-transporter 2 (SGLT2) inhibitors.

MRAs are recommended for patients with an ejection fraction of 35% or less and can help improve blood flow and heart function. SGLT2 inhibitors can assist glucose control in patients with diabetes and can reduce the risk of heart complications.

Doctors will also prescribe beta-blockers to support these efforts and control the heart rate.

Some patients may also require physical intervention to treat CHF. Doctors may advocate the use of implantable cardiac defibrillators (ICDs) and cardiac resynchronization therapy (CRT) when required. These both include attaching small electrical devices to a patient’s heart to protect against sudden cardiac arrest and regulate heart rhythm, respectively.

In the later stages of heart failure, doctors may recommend surgery to insert a left ventricular assisted device (LVAD) into the heart. An LVAD is a pump that helps the heart muscle contract. These devices can be a permanent solution for patients with heart failure.

A full heart transplant may also be an option if the person is a good candidate for the operation.

Doctors will likely recommend making lifestyle changes to minimize the impact of CHF. This will often happen regardless of the stage a person is at or other treatments they will follow. According to medical reviews, these changes may help slow the progression of heart failure conditions and increase a person’s quality of life. They include:

Diet and exercise

Eating a healthful, varied diet and getting regular exercise is always a good idea, but it can be essential for people with CHF.

Doctors may recommend that people with CHF eliminate excess salt (sodium) from their diet, as it causes the body to retain fluids. They may also suggest reducing alcohol intake and limiting fluid intake.

Regular aerobic exercise may improve heart health and lead to a better quality of life in patients with CHF. Guidance states that physical conditioning can improve quality of life, exercise tolerance, and reduce hospitalization rates in patients with heart failure. However, an increase in physical activity may not be practical for all patients.

Aerobic exercise is any activity that elevates the heart rate and breathing rate. Activities include swimming, cycling, or jogging. If you have CHF, check with your doctor before doing any exercise.

Fluid restriction

People with CHF tend to retain fluid in the body. To mitigate this, doctors will sometimes recommend patients limit their daily fluid intake within safe boundaries.

Consuming too much liquid may cancel out the effects of diuretic medicines. While it is essential to stay hydrated, a doctor will recommend just how much fluid a person can safely consume a day.

Weight

Obesity is a known risk factor for heart failure. Weight loss and subsequent management can be effective for the prevention of heart failure, research shows.

However, for patients with CHF, weight loss may not always be advised. In some circumstances, rapid weight loss may be a warning sign of other conditions, such as cachexia.

Doctors will often ask people to monitor their weight each day to check for any sudden or fast weight gain, which may be a sign of fluid retention. In addition, monitoring a person’s weight every day can help a doctor prescribe the correct levels of diuretics to help the body release fluid.

Each person with CHF will have a different experience with the condition, and life expectancy for the disease will vary significantly between individuals. Some studies estimate a 5-year survival rate of close to 50% for a person diagnosed with heart failure.

Life expectancy depends on what stage and class CHF has reached and what other complications or health problems the person has. People who have received an early diagnosis may have a better outlook than those who did not receive a diagnosis until later.

Many people find that positive lifestyle changes can significantly improve the symptoms of CHF and their well-being. In addition, medications help many people with CHF. Doctors will sometimes recommend surgery.

It is crucial that a person with CHF work directly with a doctor or medical team to make an individualized treatment plan and have the best possible outlook.