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 how the well the 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, heart valve disease, alcoholism, or a previous heart attack.

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Overall Survival

Congestive heart failure is a chronic and progressive condition where the heart is weakened and unable to pump adequate oxygen- and nutrient-rich blood that your body’s cells need to function.

In the early stages of CHF, the heart muscle stretches and develops more muscle mass, therefore 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 high risk of developing heart failure to advanced heart failure. As symptoms worsen, so does CHF, moving on to the next stage.

The prognosis of 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.

Studies that examined prognosis of chronic heart failure in patients in a managed community environment or in an outpatient setting showed the following survival rates for persons with CHF: 80-90%, (97% of the general population for the first year); 50-60% by the fifth year, (85% of the general population); and 30% by year 10—those with heart failure and left ventricular systolic dysfunction (LVSD) (75% of the general population.)

Prognosis by Stage

Prognosis depends on the stage and cause of CHF and a person’s age, sex, and socioeconomic status. The different stages of CHF include:

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. This stage can be further categorized into two stages: Early-stage C1 is clinical heart failure without prior hospitalization, while advanced-stage C2 refers to clinical heart failure with prior hospitalization

Absolute mortality rates remaining at about 50% within five years of diagnosis of CHF. Five-year mortality data for each of the four stages of CHF are:

Five-Year Survival Rates
Stage	5-Year Survival Rate
Stage A	97%
Stage B	95.7%
Stage C (Both C1 and C2	74.6%
Early-Stage C1	78%
Advance Stage C2	60%
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 found that the rate of hospitalization decreased over time for patients aged 65 and older, but grew among people 20-65 years old. Mortality rates were lower for patients in the 20-44 group, who were found to be less likely to be admitted to the emergency room or hospitalized for heart failure or other cardiac issues. Their mortality rates were still significant in 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); 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 post-menopause—include hypertension, valvular heart disease, diabetes, and coronary artery disease. Once coronary heart disease has been diagnosed, the risk of HF increases.

Exercise Tolerance

Exercise intolerance is defined by not only a reduction in maximal oxygen uptake, 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.

Three-year survival rates for patients with reduced exercise tolerance was 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. Ejection fraction dysfunction can cause different types of heart failure, including:

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 a prior heart attack. An ejection fraction rate of 40% or lower may indicate heart failure or cardiomyopathy.

Mortality rates for people with HFpEF were lower compared with people who have HFrFE. One trial showed that mortality rate increased proportionally with the decrease in the left ventricular ejection fraction with the following breakdown:

Under 15%: 51%
16-25%: 41.7%
26-35%: 31.4%
35-45%: 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 similar comorbidities as people without diabetes. However, individuals with diabetes and undiagnosed diabetes had more hospital stays due to acute heart failure from the prior year, with no differences in left ventricular ejection fraction. Yet the incidence of heart failure with systolic dysfunction (EF of less than 40%) was similar in all three groups.

Mortality rate of patients with undiagnosed diabetes were more likely to die 1.69 times more often 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 the all the possible symptoms. Don't ignore suspicious symptoms, and let your doctor know. Regular exercise and managing concurrent conditions can 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 to die 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 ages of the obese patients who were younger than patients who were of normal weight or underweight.

Weight Loss, Diabetes, and Obesity

A 2018 study published in the Canadian Journal of Diabetes recommends 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 like exercise, eating a better diet, and other behavior interventions, both weight loss and lowering 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. For people with diabetes, 25% of patients with chronic heart failure and up to 40% of these patients have acute heart failure. Heart failure is prioritized when treating both conditions at the same time. Consequently, people with diabetes and heart failure should be treated and managed by cardiologists. To reduce the risk of death, continued blood glucose control is also key.

Some strategies to prevent or manage both type 1 and type 2 diabetes include the use of beta-blockers and angiotensin-converting enzyme inhibitors, which benefit patients and is linked with a lower mortality rate and fewer hospitalizations. Angiotensin II receptor blockers have shown similar effectiveness in heart failure patients with and without diabetes.

Medications

Mineralocorticoid receptor antagonists (diuretics) are recommended to symptomatic heart failure patients, along with a combination of ACE inhibitors/angiotensin receptor blockers (ARBs) and beta-blockers.

In a trial with patients with moderate to severe symptoms of heart failure, patients were given spironolactone (a potassium-sparing diuretic). After a follow-up of two years, there was a 30% risk reduction in all-cause mortality, a 35% decrease in rehospitalization, and a 36% decrease in progressive heart failure.

Therapy Effetiveness

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 while on these treatments should be reported to your cardiologist for changes in your treatment.

A Word From Verywell

Although the prognosis for CHF is unnerving, there are numerous lifestyle changes and medications that can 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.