Heart Failure Prognosis

By Dr Ananya Mandal, MD

The prognosis or predicted outcome of heart failure depends on several factors. Clinical prediction rules are based on factors such as blood pressure, laboratory test results, patient's general health, time of detection and use of medication.

A prognosis may also be given based on cardiopulmonary exercise (CPX) testing. This test measures the amount of oxygen and carbon dioxide breathed out during exercise and the peak oxygen consumption (VO2 max) is assessed. A VO2 max of less than 12-14 cc/kg/min indicates that a person may have a poor heart failure outcome.

One clinical predictor rule is the EFFECT rule, which classifies patients according to their risk of death or long term morbidity/suffering.

Other rules for predicting prognosis include:

The ADHERE Tree rule which states that if a person has a blood urea nitrogen < 43 mg/dl and a systolic blood pressure of at least 115 mm Hg; their risk of death or complications during hospitalization is less than 10%.

The BWH rule suggests that people with the following clinical features have a less than 10% risk of death or complications during hospitalization:

  • Systolic blood pressure over 90 mm Hg
  • Respiratory rate of 30 or less breaths per minute
  • Serum sodium over 135 mmol/L
  • No new ST-T wave change on electrocardiogram or ECG

Coping with heart failure and monitoring

Taking adequate care in terms of lifestyle management by, for example, controlling diabetes and weight, stopping any smoking and alcohol abuse and eating a healthy, balanced diet as well as engaging in regular exercise can help individuals cope with long-term heart disease and heart failure.

Taking heart failure medications regularly, controlling fluid and salt intake, and receiving timely flu and other vaccinations also helps to prevent complications.

End of life care or palliative care

In very advanced and severe cases, a patient may become completely bed-ridden and experience severe symptoms even when resting. At this stage, managing pain and breathlessness becomes the prioirity, unless there is scope for a heart transplant.

Reviewed by Sally Robertson, BSc

Sources

  1. http://www.nhs.uk/Conditions/Heart-failure/Pages/Introduction.aspx
  2. http://www.heartfailureguideline.org/_assets/document/Guidelines.pdf
  3. http://www.sign.ac.uk/pdf/sign95.pdf
  4. http://www.heart.org/idc/groups/heart-public/@wcm/@hcm/documents/downloadable/ucm_300315.pdf
  5. https://www.ghc.org/all-sites/guidelines/heart-failure.pdf
  6. http://www.nlm.nih.gov/medlineplus/tutorials/congestiveheartfailure/ct129106.pdf

Further Reading

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