Determining your prognosis with heart failure

Your prognosis is the expected outcome of your disease. The prognoses of people with heart failure can vary dramatically. Several factors help your doctor estimate your prognosis.

The severity of your symptoms. It is well established that people who have more severe symptoms of heart failure do not survive as long as people who have only mild symptoms. The New York Heart Association criteria classify the disease based on symptoms. People with class IV heart failure have the poorest prognosis, while people with class I have the best.

Your overall heart function. The ejection fraction of your left ventricle is an important indicator of your prognosis. The more severely damaged your heart muscle is, the worse your ejection fraction will be. The more your heart muscle is damaged, the worse your prognosis, regardless of your symptoms.

If your ejection fraction gets worse every time you are evaluated, your prognosis will probably be worse. Your prognosis will also tend to be worse if your right ventricle is also weakened.

The cause of your heart failure. Some people have heart failure as the result of an easily treated condition. For example, heart failure can be caused by treatable conditions such as an overactive or underactive thyroid gland, anemia, or vitamin deficiencies. For these people, the prognoses for full recovery and long-term survival are generally excellent. Unfortunately, people with reversible heart failure represent a small segment of the total number of people with heart failure.

Heart failure as a result of a valve condition (such as aortic valve stenosis or mitral valve regurgitation) may also be reversible if the valve problem is recognized early and fixed before permanent damage happens.

Heart failure associated with alcohol use or pregnancy may spontaneously resolve itself over time. People with heart failure caused by severe high blood pressure (hypertension) may see considerable improvement of their symptoms when they control their hypertension.

Although it has been improving in recent years, the prognosis for most people with heart failure is still rather poor. The majority of people with heart failure have also had heart attacks from coronary artery disease (CAD). Many others have a progressive form of heart failure with an unknown cause (idiopathic cardiomyopathy). Heart failure from these causes is likely to become worse because of a number of factors that themselves gradually get worse. In almost all studies, people who have heart failure as a result of CAD have a worse prognosis and a higher death rate than people who have heart failure that is not a result of CAD.

How long you've had heart failure. If you have had heart failure symptoms for a short period of time and you receive aggressive treatment, you are more likely to have improved heart function than people with a long history of symptoms. Although there is no specific length of time after which your heart function is unlikely to improve, the longer you have had heart failure, the less likely it is that your heart function may improve significantly even with appropriate treatment.

Compensatory factors. As heart failure gets worse, the body makes various adjustments—referred to as "compensatory factors"—to correct the effects of heart failure on other organs. One such compensatory factor is an increase in various hormone levels, including renin, aldosterone, norepinephrine, atrial natriuretic peptide, and prostaglandins. Your doctor can measure the amount of these hormones in your blood, as well as the amount of sodium in your blood. Increases of these hormones and decreases in sodium can be markers of severe heart failure. Increases in these hormonal factors and other compensatory factors often make heart failure worse over time.

Last Updated: August 25, 2008

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