CHF: Prognosis and Management

CHF: Prognosis

Poor. 5-year survival around 50%. About 20% survive longer than 8-12 years.
5-year survival rate for Congestive Heart Failure: Half of the patients diagnosed with CHF will be dead within 5 years. (Source: excerpt from NHLBI, Congestive Heart Failure Data Fact Sheet: NHLBI)
Results of a new study published in the March 7 issue of Archives of Internal Medicine suggest that heart failure survival after 6 years in adults 67 years and older on Medicare is very low and may be worse than the prognosis for most types of cancer. (Source: excerpt from Facts About Heart Failure in Older Adults: CDC-OC)
This condition carries a reduced life expectancy. Many forms of heart failure can be controlled with medication, lifestyle change, and correction of any underlying disorder. Heart failure is usually a chronic illness, and it may worsen with infection or other physical stressors.
Estimated mortality rate for Congestive Heart Failure from prevalence and deaths statistics:
Deaths: 50,824 (USA annual deaths calculated from this data: 50,824 deaths (NHLBI 1999); about 260,000 deaths a year (CDC-OC))
Incidence: 4,800,000 (USA prevalence calculated from this data: 4.8 million Americans (NHLBI); 2% age 40-59; 5% age 60-69; 10% over 70's
1.1% (ratio of deaths to prevalence).
Estimated mortality rate for Congestive Heart Failure from incidence and deaths statistics:
Deaths: 50,824 (USA annual deaths calculated from this data: 50,824 deaths (NHLBI 1999); about 260,000 deaths a year (CDC-OC))
Incidence: 400,000 (USA annual incidence calculated from this data: 400,000 new cases annually
12.7% (ratio of deaths to incidence).

Naturally, such forecast issues are by their nature unpredictable.


Management for CHF

Medications
ACE inhibitors such as captopril and enalapril -- these medications open up blood vessels and decrease the work load of the heart.
Diuretics -- there are several types including thiazide, loop diuretics, and potassium-sparing diuretics; they help rid your body of fluid and sodium.
Digitalis glycosides -- increase the ability of the heart muscle to contract properly; prevent heart rhythm disturbances
Angiotensin receptor blockers (ARBs) such as losartan and candesartan which, like ACE inhibitors, reduce the workload of the heart; this class of drug is especially important for those who cannot tolerate ACE inhibitors
Beta-blockers -- this is particularly useful for those with a history of coronary artery disease
Inotropic agents help improve the heart's ability to pump blood. Such drugs include dobutamine and milrinone. They are given intravenously.


Diet Modification

Look for foods that are labeled “low-sodium,” “sodium-free,” “no salt added,” or “unsalted.” Check the total sodium content on food labels. Be especially careful of canned, packaged, and frozen foods. A nutritionist can teach you how to understand these labels. Don’t cook with salt or add salt to what you are eating. Try pepper, garlic, lemon, or other spices for flavor instead. Be careful of packaged spice blends as these often contain salt or salt products (like monosodium glutamate, MSG). Avoid foods that are naturally high in sodium, like anchovies, meats (particularly cured meats, bacon, hot dogs, sausage, bologna, ham, and salami), nuts, olives, pickles, sauerkraut, soy and Worcestershire sauces, tomato and other vegetable juices, and cheese. Take care when eating out. Stick to steamed, grilled, baked, boiled, and broiled foods with no added salt, sauce, or cheese. Use oil and vinegar, rather than bottled dressings, on salads. Eat fresh fruit or sorbet when having dessert.

Other lifestyle modifications
Don’t smoke.
Stay active..exercise. Your doctor can provide a safe and effective exercise plan based on your degree of heart failure and how well you do on tests that check the strength and function of your heart. DO NOT exercise on days that your weight has gone up from fluid retention or you are not feeling well.
Lose weight if you are overweight.
Get enough rest, including after exercise, eating, or other activities.

posted by Chris