Congestive Heart Failure: Life Expectancy and Prognosis

Congestive heart failure (CHF) occurs when the heart can’t pump an adequate amount of blood to the body. The outlook for people with this condition is generally poor, despite advances in treatment. The survival rate of a person with CHF depends upon how the well their heart is functioning, the presence of other diseases, age, CHF stage, and the person’s response to treatment.

Health conditions that can contribute to CHF include coronary artery disease, high blood pressure, cardiac arrhythmia, heart valve disease, alcoholism, or a previous heart attack.

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Overall Survival

Congestive heart failure is a chronic and progressive condition in which the heart is weakened and unable to pump enough of the oxygen- and nutrient-rich blood your body’s cells need to function.

There are two main types of heart failure. In the first, heart failure with reduced ejection fraction—also called diastolic heart failure—the heart muscle is weak and cannot adequately pump blood to the rest of the body.

The second main type of heart failure is called heart failure with preserved ejection fraction, or systolic heart failure. Here, the heart muscle is not weak, but it is stiff and has difficulty filling with blood.

In the early stages of CHF, the heart muscle stretches and develops more muscle mass, thereby contracting with more force to pump more blood. After a period of time, the heart enlarges and can’t manage its workload, which leads to fatigue, shortness of breath, increased heart rate, leg swelling, and other symptoms.

Congestive heart failure is broken down into four stages, ranging from an initial high risk of developing heart failure to advanced heart failure. As symptoms worsen, so does the stage of CHF.

The prognosis for CHF is broken down into increments of five-year mortality rates—an assessment that estimates short- and long-term survival rates from the time of a person’s CHF diagnosis and treatment.

Five-Year Survival Rate

Approximately 6.2 million adults in the United States have been diagnosed with heart failure, with a five-year survival rate of about 50% for all stages. In 2018, 379,800 deaths were determined to be a result of heart failure. Geographically, heart failure is widespread in certain regions of the United States, primarily the South and Midwest.

A review published in 2017 that examined prognosis of chronic heart failure in patients in a managed community environment or an outpatient setting reported the following average survival rates for persons with CHF: 80-90% after one year (versus 97% of the general population); 50-60% by the fifth year (versus 85% of the general population); and about 30% by year 10 (versus 75% of 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 structural heart disease or symptoms of heart failure
Stage B: Structural heart disease, but without signs or symptoms of heart failure
Stage C: Structural heart disease with prior or current symptoms of heart failure
Stage D: Advanced heart failure

The table below shows five-year mortality data for each of the four stages of CHF.

Five-Year Survival Rates
Stage	5-Year Survival Rate
Stage A	97%
Stage B	95.7%
Stage C	74.6%
Stage D	20%

Factors Affecting Survival

Numerous factors may affect a person’s survival rate, including age, sex, exercise tolerance, and other medical conditions.

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 steadily increase with age.

A clinical trial looking at the rate of hospitalization among patients across the age spectrum (20 through 65 and older) found that mortality rates were lower for patients in the 20-44 group. This group was less likely to be admitted to the emergency room or hospitalized for heart failure or other cardiac issues. However, mortality 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 concluded that serious CHF occurrences were more frequent in 50% of people who were readmitted to the hospital (two-thirds went to the emergency room, and more than 10% died within 12 months).

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 nonischemic heart failure have a better chance of surviving than men either with or without heart disease as their main cause of heart failure.

Comorbidities found in women with heart failure—especially those who are past menopause—include hypertension, valvular heart disease, diabetes, and coronary artery disease. Once coronary heart disease has been diagnosed, the risk of CHF increases.

Exercise Tolerance

Exercise intolerance is defined by not only a reduction in maximal oxygen uptake—defined as the maximum amount of oxygen a person can use during an intense workout—but also the restricted capability to carry out any physical activity. CHF symptoms include labored breathing and fatigue. In addition, low exercise tolerance is a key symptom in CHF that is associated with poor quality of life and an increased mortality rate.

Contributors of exercise intolerance include:

Reduced cardiovascular reserve
Reduced pulmonary reserve
Structural and/or functional skeletal muscle malformations

Other factors such as anemia and obesity also play a role in exercise tolerance.

The three-year survival rate for patients with reduced exercise tolerance is 57%, compared with 93% in those with normal exercise tolerance.

Ejection Fraction

Ejection fraction measures the percentage of blood that is pumped out by the left ventricle with each contraction. Left ventricular function is used to classify different types of heart failure. If the ejection fraction is normal, this is termed heart failure with preserved ejection fraction. If the ejection fraction is diminished, this is termed heart failure with reduced ejection fraction.

Preserved ejection fraction (HFpEF), or diastolic heart failure: The heart contracts normally, but the ventricles do not relax during ventricular filling.
Reduced ejection fraction (HFrEF), or systolic heart failure: The heart does not contract sufficiently, leading to less oxygen-rich blood being pumped out to the body.

Normal ejection fraction rates range between 50% and 70%. An ejection fraction between 41% and 49% falls in the borderline classification, which doesn’t necessarily indicate that the individual is developing heart failure, but may signal a damaged heart or prior heart attack. An ejection fraction rate of 40% or lower may indicate heart failure or cardiomyopathy.

Mortality rates for people with diastolic heart failure are lower compared to people who have systolic heart failure. One trial showed that mortality rate increased proportionally with the decrease in left ventricular ejection fraction.

Under 15% left ventricular ejection fraction: 51%
16-25% left ventricular ejection fraction: 41.7%
26-35% left ventricular ejection fraction: 31.4%
35-45% left ventricular ejection fraction: 25.6%

Diabetes

Type 2 diabetes is considered an independent risk factor and increases morbidity and mortality rates of people with CHF. About 20-40% of heart failure patients have diabetes, and at least 10% of high-risk cardiovascular patients may have undiagnosed diabetes.

According to a study that examined the frequency of diabetes and acute heart failure in a group of 400 patients, 203 men and 197 women with an average age of 71 years fell into the following glycemic distribution: 37% had clinical diabetes, 16% had undiagnosed diabetes, and 47% percent did not have diabetes.

People with diabetes were more likely to have hypertension, dyslipidemia, peripheral vascular disease, and a previous heart attack. Those with undiagnosed diabetes were likely to have comorbidities similar to those in people without diabetes. However, individuals with diabetes and undiagnosed diabetes had more hospital stays due to acute heart failure in the prior year, with no differences in left ventricular ejection fraction. Yet the incidence of heart failure with systolic dysfunction (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 a lower cardiovascular risk profile compared with people with diabetes, but mortality rates were similar between the two groups.

Hospitalization

Heart failure relapses that require hospitalization often indicate a bad outcome. These symptomatic relapses also point to progression of the condition. The 30 days after initial hospitalization are viewed as a high-risk period and require intensive follow-up and monitoring.

What You Can Do

Although some risk factors of heart failure, like age, can’t be modified, people with CHF can take actions to improve their long-term prognosis. The first step is to become familiar with any family history of heart disease and learn about all the possible symptoms. Don't ignore suspicious symptoms: let your doctor know about them. Regular exercise and managing concurrent conditions can also help keep CHF under control.

Coping With Heart Failure

Exercise

People who are diagnosed with heart disease have no reduced mortality risk linked to weight loss, but ongoing and sustained physical activity are associated with considerable risk reduction.

Another study examined patients with diabetes who were hospitalized for heart failure. Of those patients, 65% were overweight or obese and 3% were underweight. Patients who were underweight and diabetic had a 50% chance of dying within five years. The odds were lower by 20% to 40% for those with obesity than patients at normal weights. The inverse relationship between obesity and reduced mortality rate may be explained by the age of the obese patients, who were younger than the normal-weight or underweight patients in the study.

Weight Loss, Diabetes, and Obesity

A 2018 study published in the Canadian Journal of Diabetes suggests that a sustained weight loss of more than 5% of body weight will lead to an improvement in glycemic control and cardiovascular risk factors. By employing healthy lifestyle choices such as exercise, eating a better diet, and other behavior interventions, both weight loss and lowering hemoglobin A1C can be reached.

Medication to manage weight may improve glycemic and metabolic control in both people with diabetes and obese patients, and, when deemed appropriate, bariatric surgery may be an option for obese and diabetic patients.

Before you begin any sort of weight-loss program, consult with your cardiologist and diabetes management team first.

Diabetes Control

Diabetes is associated with the risk of developing heart failure. Among people with diabetes, 25% have chronic heart failure and up to 40% have acute heart failure. Consequently, people with diabetes and heart failure are treated and managed by cardiologists. To reduce the risk of death, continued blood glucose control is also key.

Angiotensin-converting enzyme (or ACE) inhibitors are often used as an adjunct therapy in both type 1 and type 2 diabetes. ACE inhibitors have a number of benefits for these conditions and are linked with a lower mortality rate and fewer hospitalizations. Angiotensin II receptor blockers, or ARBs, have also shown similar effectiveness in heart failure patients with and without diabetes.

Medications

In heart failure with reduced ejection fraction, a few medications have been shown to reduce mortality and hospitalizations. Specifically, doctors may prescribe the following medications in some combination:

Beta-blockers (carvedilol, metoprolol succinate, or bisoprolol)
Entresto (sacubitril/valsartan)
An ARB or ACE inhibitor
Spironolactone
Sodium glucose co-transporter 2 (SGLT2) inhibitors

In heart failure with preserved ejection fraction, no medications have been shown to improve mortality, but there is some suggestion of benefit when using spironolactone.

How Heart Failure Is Treated

Therapy Effectiveness

Heart failure prognosis has improved due to new drug therapies. However, the effectiveness of these therapies can change over time. New symptoms, or worsening ones, that surface should be reported to your cardiologist, who can evaluate you for possible changes in your treatment.

A Word From Verywell

Although the prognosis for CHF may be unnerving, there are numerous lifestyle changes and medications that can help slow down the progression of the condition and increase your chances of survival. You can be proactive in managing the condition by monitoring your symptoms, eliminating unhealthy habits, exercising regularly, and eating a healthy diet.