Internal Medicine

Life expectancy with heart failure

introduction

Heart failure (heart failure) is one of the most common diseases and causes of death in Germany.

20% of those over 60 suffer from it. For those over 70 years of age it is even 40%. Statistically speaking, women are less often affected than men, but the modern way of life also increases the number of sick women. Cardiac insufficiency in older people is usually a chronic event; the symptoms develop slowly and are often not recognized immediately. The further the weakness has progressed, the worse the prognosis. Younger people are very rarely affected, this is usually an acute heart failure based on a congenital malformation.

In general, cardiac insufficiency cannot be cured and the prognosis is comparatively poor. 50% of those affected survive the next 5 years after diagnosis. Heart muscle cells find it very difficult or impossible to regenerate. With targeted, consistent therapy, however, the process can be slowed down and life expectancy increased.

These factors have a positive effect on life expectancy in the case of heart failure

An elementary component of the therapy for a heart failure is the so-called lifestyle change - an improvement and change in living conditions.

A normalization of body weight is the top priority. A balanced and low-salt diet is of great importance. This type of diet is also known as Mediterranean food, with lots of fresh vegetables, fruit, fish and high-quality oils (olive oil, coconut oil).

The second important factor is sufficient exercise, in the form of light endurance sports. Cycling, swimming or hiking are great ways to keep your cardiovascular system going. However, before endurance training, your performance should be checked by a doctor. An optimal therapy can be planned as part of an exercise ECG. In general, it is important to keep these changes permanently, even if the beginning is difficult. With these measures, the patient himself can have a major influence on his prognosis, especially in the early stages of the disease.

Rest and a safe environment for the patient is also important. By avoiding stress, the heart can be spared in the long term. In addition, existing diseases and risk factors that favor heart failure must be quickly identified and eliminated. Regular blood pressure monitoring and consistent adjustment is essential. Here, the success of the therapy is again dependent on the cooperation of the patient. The course of the disease can only be improved if prescribed tablets are taken regularly.

The female sex hormone estrogen has a positive so-called cardioprotective effect on the heart and blood vessels, so women are less often affected.

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Negative factors influencing life expectancy in the case of heart failure

The factors that have a negative impact on heart failure include above all being overweight, but being severely underweight also permanently weakens the heart.

A balanced, rich diet is an integral part of basic therapy. Food such as meat (especially red meat and sausage), sugary foods and drinks (cola, Fanta, energy drinks) and fast food should be avoided. Saturated fatty acids such as those found in animal products (whole milk, fatty cheese) are particularly harmful. Not only does fat lead to rapid weight gain, it also increases cholesterol levels. This is deposited in vessels and causes vascular occlusion and promotes the development of coronary heart disease and heart attacks, which in turn can be causes of heart failure.

It is similar with the consumption of alcohol and nicotine. Patients with cardiac insufficiency should consistently avoid it. Another negative factor is mental stress. The release of stress hormones increases the heart rate and puts additional strain on the weakened heart.

Heart failure patients often have a number of other diseases that negatively affect one another. These include diabetes, high blood pressure or cardiac arrhythmias. The effects on the heart can be reduced through long-term drug therapy for the underlying diseases and regular blood sugar and blood pressure monitoring.

If heart failure occurs acutely on so-called acute heart failure, life expectancy drops sharply and often ends fatally after a few hours.

Life expectancy in stage 1

Heart failure in stage 1 means that structural changes in the heart can already be recognized or a reduction in the heart's output capacity can be measured.

However, the person concerned has no symptoms, neither at rest nor under heavy stress. More than 100 watts can be reached during a stress test. The cardiac output is normal. It is therefore difficult to diagnose heart failure at this stage, as many patients do not feel sick and do not see a doctor. Stage 1 heart failure is usually recognized in connection with other diseases. As part of a check-up for coronary artery disease, a heart attack, high blood pressure or a routine examination by the family doctor, possible changes in the ECG or when listening to the heart and lungs become apparent.

If the heart failure is detected at this early stage, therapy must be initiated immediately. Even if there are no symptoms, it must be clear to the patient that it is a serious illness that cannot be cured. In stage 1, an annual mortality of between 8-18% is to be expected. The prognosis can only be improved through consistent therapy. Strict adjustment of blood pressure, heart rate and blood sugar can relieve the heart over the long term.

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Life expectancy in stage 2

Stage 2 heart failure is characterized by symptoms under moderate exertion.

Shortness of breath and exhaustion occur e.g. when climbing stairs after 2 floors. There are no symptoms at rest or during light exercise. During this time, most patients come to the doctor because they feel restricted in their performance. Structural changes are now clearly visible and the ejection volume of the heart is already clearly restricted.

In addition to a consistent lifestyle change, drug therapy must be intensified to slow the progression of the disease and to alleviate symptoms such as leg edema, pulmonary edema or cardiac arrhythmias. Life expectancy decreases as the disease progresses. The later the cardiac insufficiency is recognized, the worse the prognosis. Statistically, the annual mortality rate is 10-20%. Drugs like ACE inhibitors can reduce mortality significantly. However, they must be taken regularly for life. A cure is not possible. The therapy should be checked every 6-12 months.

Life expectancy in stage 3

In stage 3, symptoms occur even with light exertion.

Climbing stairs to the first floor is much more difficult and causes shortness of breath and weakness. Only 50 watts are achieved in stress tests. Patients are clearly restricted in their everyday life and need help. At this stage the mortality increases dramatically to 50%.

A drug therapy can be increased and expanded further. Advice on further, including surgical, measures must be given in good time. A pacemaker can be implanted to support the heart muscles. The heart can also be relieved by reconstruction or replacement of heart valves. However, every operation carries a significantly higher risk for patients with cardiac insufficiency. A therapy check is necessary every 3 months.

Life expectancy at stage 4

In the end stage of cardiac insufficiency, symptoms already appear at rest. A burden is no longer possible. The ejection volume of the heart drops below 30%.

Acute decompensations (deterioration) pose a particular risk. Complications such as a sudden drop in blood pressure, cardiac arrhythmia, stroke, kidney failure, and even cardiac arrest are possible. Those affected must be admitted to hospital immediately.

Without surgical measures, the 1-year life expectancy sometimes drops to 10-15%. Cardiac resynchronization therapy (CRT) or the implantation of cardiac assist systems can improve the quality of life in the end-stage. A possible heart transplant should be advised in young patients. Stage 4 patients should be reassessed every month to change therapy if necessary.