Heart Failure and Life Expectancy

If you learn that you have heart failure, don’t let the name mislead you. Your heart hasn’t failed. Rather, you have a condition in which your heart has trouble pumping oxygen-rich blood to the rest of your body.

“That can result in a backup of fluid into the lungs and congestion in the lungs, causing shortness of breath, chest pain, and fatigue, as well as the backup of fluid elsewhere in the body,” says Brent Lampert, DO, a cardiologist at The Ohio State University Wexner Medical Center in Columbus.

Depending on how serious your heart failure is, you may notice swelling in your ankles and legs. Your heart may beat faster than usual, or its rhythm may not be as regular. Your stomach may swell, and you could lose your appetite.

It’s a serious diagnosis. But doctors have learned a lot about how to treat heart failure with close care, often including a combination of prescription drugs that provides the most relief from symptoms.

And life expectancy is on the rise: Roughly half of people diagnosed today can expect to live at least 5 more years, compared with 41% in 2000, according to one study.

Special calculators offer an estimate of your life expectancy with heart failure. With one online tool, the Seattle Heart Failure Model, you can put in your lab results and the type of treatment you’re getting to project your odds.

But keep in mind that such calculators are based on large groups of people and may not include the latest research, says Gregg Fonarow, MD, a cardiologist who directs the Ahmanson-UCLA Cardiomyopathy Center in Los Angeles.

“Even the most accurate risk models aren’t going to get it right for most individuals,” Fonarow says. “The best thing is talk to your physician, who can help you interpret all over your risk factors, rather than trying to figure out your risk on your own.”

What Determines Life Expectancy?

Some things that affect your life expectancy with heart failure are out of your control, such as your age. Others, such as a healthy lifestyle, are not.

Things that may affect life expectancy include:

Ejection fraction. To get a better picture of your heart health, your doctor will check how well an area of your heart called the left ventricle pumps out blood. An echocardiogram is one test that’s often used. It scans the heart and takes measurements to find out what percentage of your blood is being pumped out with each heartbeat. For instance, an ejection fraction of 55% means that 55% of your blood is being pushed out with each thump. A normal result usually falls between 50% and 70%, according to the American Heart Association.

People with a reduced ejection fraction have one type of the condition. It’s called heart failure with reduced left ventricular function. With the other type, heart failure with preserved left ventricular function, the percentage isn’t below normal. But there are other changes, such as the heart becoming stiffer. “After the heart squeezes and pumps blood forward, it has to relax to fill with blood,” Lampert says. “When the heart muscle is stiff or unable to relax as blood is trying to rush in and fill it, it’s not very compliant, and so you can get that same results of fluid backing up into the lungs and other parts of the body.”

If your heart failure involves a reduced ejection fraction, your doctor will watch that number closely. If it drops too low, to 35% or below, you have a higher risk of a possibly life-threatening heart rhythm.

Staging. There are four stages of heart failure, which indicate how serious your condition may be.

• Stage A: You don’t have full heart failure, but you have some risk factors. You may have a family member with heart failure. Or you may have other medical conditions, such as high blood pressure, alcohol abuse, diabetes, or heart disease.
• Stage B: Tests show that your heart has had some damage, but you don’t notice any symptoms. Most likely, you had a below-normal result on a heart function test. Most people with Stage B have an ejection fraction of 40% or less.
• Stage C: You have some symptoms that may come and go, such as tiredness. You may be less able to exercise, have swollen or weak legs, or have shortness of breath.
• Stage D: Your symptoms are more serious and don’t improve with medication and other treatment.

Lifestyle choices. There are things you can do today to improve the quality of your life as well as possibly extend it, Lampert says. Smokers should try to quit, and he advises bypassing alcohol. “I generally advise people to avoid it.”

Stay as active as possible under a doctor’s direction or with a cardiac program, Lampert says. Follow recommendations to limit sodium and how much fluid you drink.

Even these small dietary steps may have a large impact, Lampert says.

“One factor that is associated with a shorter length of life is recurrent hospitalizations,” he says. “Every time you are hospitalized, life expectancy shortens. If you can control fluid and sodium and stay out of the hospital, that can certainly help both quality and quantity of life.”

Keeping up with medications. This might seem obvious, but both Lampert and Fonarow stress the importance of not skipping your meds. You will probably need to take several medications for your heart failure. They may have side effects, and how well they work may change as your condition changes.

“When you do develop symptoms, report those, and stay in close contact with your physician,” Lampert says. “So if you are starting to worsen, they can act on it quickly.”

The good news is that recent research shows that taking a combination of medications for heart failure helps extend life expectancy in people with reduced ejection fraction, Fonarow says. In one study, the medication combination boosted survival by an average of 6 years across all age groups.

“There’s been an important and critical revolution in our ability to diagnose and treat patients with heart failure,” Fonarow says. “Because it’s not been any single one medication alone, but it’s this combination, it has not gotten the attention that it rightly deserves.”