cardiovascular disorders
Heart Failure (HF)
Prognosis for Heart Failure
Generally, patients with heart failure have a poor prognosis unless the cause is correctable. Overall combined 5 year survival is 35% for patients with HFpEF or HFrEF after an initial hospitalization for heart failure. In overt chronic HF, mortality depends on severity of symptoms and ventricular dysfunction and can range from 10 to 40%/year. Specific factors that suggest a poor prognosis include hypotension, low ejection fraction, presence of coronary artery disease, troponin release, elevation of BUN, reduced GFR, hyponatremia, and poor functional capacity (eg, as tested by a 6-minute walk test). BNP, NTproBNP, and risk scores such as theMeta-Analysis Global Group in Chronic Heart Failure (MAGGIC) Risk Scoreand theSeattle Heart Failure model, are helpful to predict prognosis in HF patients as an overall group, although there is significant variation in survival among individual patients. HF usually involves gradual deterioration, interrupted by bouts of severe decompensation, and ultimately death, although the time course is being lengthened with modern therapies. However, death can also be sudden and unexpected, without prior worsening of symptoms. All patients and family members should be taught about disease progression and the risk of sudden cardiac death. For some patients, improving quality of life is as important as increasing quantity of life. Thus, it is important to determine patients’ wishes about resuscitation (eg, Endotracheal Tubes , CPR [cardiopulmonary respiration]) if their condition deteriorates, especially when HF is already severe. All patients should be reassured that symptoms will be relieved, and they should be encouraged to seek medical attention early if their symptoms change significantly. Involvement of pharmacists, nurses, social workers, and clergy (when desired), who may be part of an interdisciplinary team or disease management program already in place, is particularly important in The Dying Patient . 