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Old 01-13-2020, 09:52 AM
Machine Elf is offline
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prognosis for untreated congestive heart failure?


Not looking for medical advice here - just a forecast.

An overweight elderly acquaintance (70-80 years old) has been living for many years with untreated hypertension. During my most recent visit with them, they exhibited shortness of breath during light exertion (e.g. walking) and hyperhydrosis, both of which I understand to be associated with congestive heart failure.

They tried blood pressure medication years ago, but quickly discontinued it years ago due to inability to tolerate side effects. It's unlikely that they can be convinced to seek treatment for heart failure.

What might we expect in terms of life expectancy and quality of life for this person?
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Old 01-13-2020, 11:54 AM
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That'd depend on the actual severity of their heart failure, along with the cause of it. To figure that out we'd need to know where they were regarding their symptoms and signs (objective assessment).

Class Patient Symptoms
I No limitation of physical activity. Ordinary physical activity does not cause undue fatigue, palpitation, dyspnea (shortness of breath).
II Slight limitation of physical activity. Comfortable at rest. Ordinary physical activity results in fatigue, palpitation, dyspnea (shortness of breath).
III Marked limitation of physical activity. Comfortable at rest. Less than ordinary activity causes fatigue, palpitation, or dyspnea.
IV Unable to carry on any physical activity without discomfort. Symptoms of heart failure at rest. If any physical activity is undertaken, discomfort increases.

Class Objective Assessment
A No objective evidence of cardiovascular disease. No symptoms and no limitation in ordinary physical activity.
B Objective evidence of minimal cardiovascular disease. Mild symptoms and slight limitation during ordinary activity. Comfortable at rest.
C Objective evidence of moderately severe cardiovascular disease. Marked limitation in activity due to symptoms, even during less-than-ordinary activity. Comfortable only at rest.
D Objective evidence of severe cardiovascular disease. Severe limitations. Experiences symptoms even while at rest.

So it's be nice to know if they were IA or or IID or IIIC or whatever to start with.

Then we'd need to know if this was due to old heart muscle injury (heart attacks or other causes) vs valvular disease vs chronic arrhythmias, or a combination of that stuff, plus other causes. Plus it'd be nice to know if those causes of problems were still active or had been fixed, along with how long and how rapidly it's been progressing.

TLDR: It's complicated

Last edited by Qadgop the Mercotan; 01-13-2020 at 11:55 AM.
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Old 01-13-2020, 12:34 PM
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QtM is the doctor.

All I can add is that I've seen numerous instances of folk carrying diagnoses of CHF for years w/o dropping dead, despite any number of associated risk factors/behaviors. It can be VERY difficult to get medical personnel to offer even the broadest estimate of life expectancy. And even if they do, there are always exceptions.
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Old 01-13-2020, 12:50 PM
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When my mother was diagnosed with it in 2001, the literature gave a lifespan of 5 years. She was dead 15 months later.
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Old 01-13-2020, 01:28 PM
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In addition to Qadgop’s explanation of why it’s complicated, it’s not certain that CHF is the source of this person’s symptoms. There are other things that can cause dynpea on exertion ranging from symptomatic anemia to angina to fluid overload from something other than CHF (kidney failure, liver failure) to plain old deconditioning. In short it sounds like their quality of life is already pretty bad if they’re getting out of breath walking around the house and it’s not going to get any better. We can’t make any predictions about their life expectancy without a lot more information.
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Old 01-13-2020, 01:31 PM
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Mileage varies so widely -------- any guess other than the one made by the treating doctor has almost no chance of being right.
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Old 01-15-2020, 10:16 PM
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It must depend on whether or not it involves a heart attack, right? My dad only survived six months after being diagnosed with congestive heart failure but it was following a fairly serious heart attack. Doctors felt his odds of surviving heart surgery were very low given how advanced his COPD was, so he was only treated with medication and opted for hospice.
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Old 01-15-2020, 11:11 PM
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Quote:
Originally Posted by Darren Garrison View Post
When my mother was diagnosed with it in 2001, the literature gave a lifespan of 5 years. She was dead 15 months later.
Does anyone know if ventricular assist devices make life expectancy longer now? I don't know if they were in use in 2001.

I did find this.

https://www.bhf.org.uk/informationsu.../medical/lvads

Quote:
The longest that we’ve supported a patient for with an LVAD has been five and a half years. Nowadays, 80–85 per cent of patients are alive a year after having an LVAD fitted and 70–75 per cent after two years. This is fantastic considering that many of them would only have had a life expectancy of 12 months or less before their LVAD treatment.
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Last edited by Wesley Clark; 01-15-2020 at 11:12 PM.
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Old 01-16-2020, 06:27 AM
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Quote:
Originally Posted by Wesley Clark View Post
Does anyone know if ventricular assist devices make life expectancy longer now? I don't know if they were in use in 2001.
Lots of info here. Given that they are typically used to keep transplant candidates alive and healthy(ish) until a donor heart can be found, it seems fair to say that they do indeed increase life expectancy. Probably the most famous case of this was former VP Dick Cheney, who received an LVAD in 2010 that kept him going until he could receive a transplanted heart a couple of years later.

Quote:
Originally Posted by Qadgop the Mercotan
TLDR: It's complicated
Makes sense. Unfortunately this person is not likely to visit a doctor any time in the near future, at least not until symptoms become really problematic (I'm assuming their condition will progress further over time). Thanks to you and others here for your input.
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Old 01-16-2020, 09:09 AM
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No doctor, but would consider doctors recommending this first.
  #11  
Old 01-16-2020, 10:20 AM
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Quote:
Originally Posted by Razncain View Post
No doctor, but would consider doctors recommending this first.
That article, while making some valid observations about coronary artery disease prevention and treatment, does not even mention congestive heart failure. So I won't recommend a plant based diet as first line treatment for management of CHF, tho it would probably be a good preventive measure for a lot (but NOT all) of causes of CHF.
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Old 01-16-2020, 12:11 PM
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There are a lot of other possible diagnoses here, so I could not conclude your diagnosis is the one. Shortness of breath on exertion has a lot of causes including angina, COPD, asthma, obesity and other lung, heart and kidney pathologies. Heart failure often presents with swollen legs and crackly sounding lungs with a wet looking chest X-ray.

If it is heart failure, treatments can be very effective but this depends on degree, other medical problems, motivation, compliance with medicine and sometimes fluid restriction, smoking and oxygen use, and so forth. Informed people can refuse treatment but depression is also common in this population. Sweating by itself is not usually diagnostic.
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Old 01-16-2020, 02:14 PM
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Quote:
Originally Posted by Dr_Paprika View Post
Heart failure often presents with swollen legs
This is one of the signs that doesn't require any special testing or training to observe.
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Old 01-16-2020, 07:44 PM
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Yes and no. Swollen legs from retained fluid can be very obvious, especially with severe untreated cases. Again, this has several causes and not all swelling leaves a mark if you push on it. The size of the mark can also be typed.

Heart failure can be systolic or diastolic; left sided or right sided; due to many causes. Itís complicated. But untreated mortality can be well under 20% or exceed 50% depending on cause. If this is the right diagnosis, which can be (but is often not) straightforward.
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