Congestive heart failure: life expectancy and prognosis


Congestive heart failure (CHF) occurs when the heart cannot pump enough blood to the body. The outlook for people with this condition is generally poor, despite advances in treatment. The survival rate of a person with CHF depends on how well their heart is working, the presence of other diseases, age, the stage of the CHF, and the person's response to treatment.

Health conditions that can contribute to congestive heart failure include coronary artery disease , high blood pressure , heart arrhythmias , heart valve disease, alcoholism, or a previous heart attack .

Average survival

Congestive heart failure is a chronic, progressive condition in which the heart becomes weak and cannot pump enough oxygen and nutrient-rich blood for the cells in your body to function.

There are two main types of heart failure. In the first case, heart failure with reduced ejection fraction, also called diastolic heart failure, the heart muscle is weak and cannot adequately pump blood to the rest of the body.

The second main type of heart failure is called ejection fraction heart failure or systolic heart failure. Here the heart muscle is not weak, but rather stiff and difficult to fill with blood.

In the early stages of CHF, the heart muscle stretches and develops more muscle mass, so it contracts harder to pump more blood. After a while, the heart grows in size and cannot cope with its load, leading to fatigue, shortness of breath, heart palpitations, leg swelling, and other symptoms.

Congestive heart failure is divided into four stages, from an initial high risk of developing heart failure to severe heart failure. As symptoms get worse, so does the CHF stage.

The prognosis for congestive heart failure is divided into five-year mortality rates, an estimate that calculates short-term and long-term survival rates from the time a patient is diagnosed and treated.

Five-year survival rate

Approximately 6.2 million adults in the United States of America have been diagnosed with heart failure, with a five-year survival rate of approximately 50% in all stages. In 2018, 379,800 people were found to have died of heart failure. Geographically, heart failure is widespread in parts of the United States, especially the South and the Midwest.

A 2017 review that examined the prognosis of chronic heart failure in patients in a controlled community or outpatient setting reported the following average survival rates for people with CHF: 80-90% per year (vs 97% for the General population). ; 50-60% at the fifth year (compared to 85% of the total population); and about 30% by year 10 (compared to 75% for the general population).

Stage forecast

The prognosis depends on the stage and cause of the CHF, as well as the age, sex, and socioeconomic status of the person. The ICC stages range from A to D.

  • Stage A: High risk for heart failure, but no structural heart disease or symptoms of heart failure.
  • Stage B: structural heart disease, but no signs or symptoms of heart failure.
  • Stage C: structural heart disease with previous or current symptoms of heart failure.
  • Stage D: severe heart failure

The following table shows five-year mortality data for each of the four stages of CHF.

Five-year survival rate
Stage 5-year survival rate
Stage a 97%
Stage B 95.7%
Stage C 74.6%
Stage D twenty%

A Discussion Guide for Health Professionals in Heart Failure

Get our printed guide to your next doctor's appointment to help you ask the right questions.

Factors affecting survival

A person's survival can be influenced by many factors, including age, gender, exercise tolerance, and other medical conditions.


Heart failure generally affects the elderly (middle-aged and older). Among Medicare patients, this is the leading reason for hospitalization. Complications of CHF also increase steadily with age.

A clinical study of hospital admission rates among patients of all ages (20 to 65 years and older) showed that death rates were lower for patients in the 20 to 44 age group. This group is less likely to be admitted to the emergency room or hospitalized for heart failure or other heart conditions. However, mortality rates among people under 44 years of age remained significant after 30 days (3.9%), one year (12.4%), and five years (27.7%). The study concluded that severe congestive heart failure was more common in 50% of people who were rehospitalized (two-thirds went to the emergency department and more than 10% died within 12 months).


Women with CHF tend to live longer than men, unless the cause is ischemia (insufficient blood supply to the heart muscles). In fact, women with non-ischemic heart failure are more likely to survive than men with or without heart disease, which is the leading cause of heart failure.

Comorbidities found in women with heart failure, especially those who have been through menopause, include hypertension, heart valve disease, diabetes, and coronary artery disease. Once coronary artery disease is diagnosed, the risk of congestive heart failure increases.

Exercise tolerance

Exercise intolerance is defined not only by a decrease in maximum oxygen consumption, defined as the maximum amount of oxygen that a person can use during intense exercise, but also by a limitation in the ability to perform any physical activity. Symptoms of CHF include shortness of breath and fatigue. Additionally, low exercise tolerance is a key symptom of congestive heart failure associated with poor quality of life and increased mortality.

Exercise intolerance factors include:

  • Decreased cardiovascular reserve
  • Decreased lung reserve
  • Structural and / or functional malformations of skeletal muscle

Other factors such as anemia and obesity also affect exercise tolerance.

The three-year survival rate for patients with reduced exercise tolerance is 57% compared to 93% for patients with normal exercise tolerance.

Ejection fraction

The ejection fraction measures the percentage of blood that is pumped through the left ventricle with each beat. Left ventricular function is used to classify different types of heart failure. If the ejection fraction is normal, it is called preserved heart failure. If the ejection fraction is low, it is called heart failure with a low ejection fraction.

  • Preserved ejection fraction (HFpEF) or diastolic heart failure: The heart beats normally, but the ventricles do not relax during ventricular filling.
  • Reduced Ejection Fraction (HFrEF) or Systolic Heart Failure: The heart does not contract enough, causing oxygen-rich blood to be pumped into the body.

Normal levels of ejection fraction are between 50% and 70%. An ejection fraction between 41% and 49% falls into a borderline classification, which does not necessarily indicate that a person is developing heart failure, but may indicate damage to the heart or a previous heart attack. An ejection fraction level of 40% or less may indicate heart failure or cardiomyopathy.

The death rate in people with diastolic heart failure is lower than in people with systolic heart failure. One study showed that the mortality rate increased in proportion to the decrease in the left ventricular ejection fraction.

  • Less than 15% Left ventricular ejection fraction: 51%
  • 16-25% Left ventricular ejection fraction: 41.7%
  • 26-35% Left ventricular ejection fraction: 31.4%
  • 35-45% Left ventricular ejection fraction: 25.6%  


Type 2 diabetes is considered an independent risk factor and increases morbidity and mortality in people with CHF. Approximately 20-40% of heart failure patients have diabetes, and at least 10% of high-risk cardiovascular patients may have undiagnosed diabetes.

According to a study that looked at the incidence of diabetes and congestive heart failure in a group of 400 patients, 203 men and 197 women with an average age of 71 fell into the following glycemic distribution: 37% had clinical diabetes, 16% did not have diabetes. diagnosed with diabetes, and 47% percent did not have diabetes.

People with diabetes were more likely to have hypertension, dyslipidemia, peripheral vascular disease, and a previous heart attack. People with undiagnosed diabetes are likely to have comorbid conditions similar to those without diabetes. However, people with diabetes and undiagnosed diabetes were more likely to be hospitalized for acute heart failure in the previous year, with no difference in left ventricular ejection fraction. However, the rate of heart failure with systolic dysfunction (ejection fraction less than 40%) was similar in the three groups.

Patients with undiagnosed diabetes are 1.69 times more likely to die than those without diabetes. Patients with undiagnosed diabetes showed a lower cardiovascular risk profile compared to people with diabetes, but the mortality rates were similar between the two groups.


Recurrent heart failure that requires hospitalization often indicates a poor prognosis. These symptomatic relapses also indicate the progression of the condition. The 30 days after the initial hospitalization is considered a high-risk period and requires intensive follow-up and monitoring.

What can you do

Although some heart failure risk factors, such as age, cannot be changed, people with CHF can take steps to improve their long-term outlook. The first step is to know the family history of heart disease and to know the possible symptoms. Don't ignore suspicious symptoms – report them to your doctor. Regular exercise and treatment for related conditions can also help keep CHF under control.

The exercise

People diagnosed with heart disease do not have a reduction in mortality risk associated with weight loss, but consistent and consistent physical activity is associated with a significant reduction in risk.

Another study looked at diabetic patients hospitalized for heart failure. Of these patients, 65% were overweight or obese and 3% were underweight. Underweight patients with diabetes had a 50% chance of dying within five years. The odds were 20-40% lower in obese patients than in normal weight patients. The inverse relationship between obesity and reduced mortality can be explained by the age of obese patients who were younger than normal or underweight patients in the study.

Weight loss, diabetes and obesity.

A 2018 study published in the Canadian Journal of Diabetes suggests that sustained weight loss of more than 5% of body weight will lead to better glycemic control and cardiovascular risk factors. By choosing healthy lifestyles such as exercising, eating a better diet, and using other behavioral interventions, both weight loss and lowering of hemoglobin A1C can be achieved.

Weight control medications can improve glycemic and metabolic control in diabetic and obese patients and, when deemed appropriate, bariatric surgery may be an option for obese and diabetic patients.

Before embarking on any weight loss program, check with your cardiologist and diabetes care team first.

Diabetes control

Diabetes is associated with the risk of heart failure. Among people with diabetes, 25% have chronic heart failure and up to 40% have acute heart failure. Therefore, patients with diabetes and heart failure are treated by cardiologists. Keeping blood glucose levels under control is also key to reducing the risk of death.

Angiotensin converting enzyme (or ACE) inhibitors are often used as add-on therapy for type 1 and type 2 diabetes. ACE inhibitors have several benefits in these conditions and are associated with lower mortality and fewer hospitalizations. Angiotensin II receptor blockers, or ARBs, have also shown similar efficacy in heart failure patients with and without diabetes.


In heart failure with reduced ejection fraction, some drugs have been shown to reduce mortality and hospitalization. In particular, healthcare providers may prescribe the following medications in some combination:

In heart failure with preserved ejection fraction, drugs have not been shown to improve mortality, but there is speculation about the benefits of spironolactone.

The effectiveness of therapy

The prognosis of heart failure has improved with new drugs. However, the effectiveness of these treatments can change over time. New or worsening symptoms should be reported to a cardiologist who will evaluate you for possible changes in your treatment.

Get the word of drug information

While the prognosis for congestive heart failure can be alarming, there are many lifestyle changes and medications that can help slow the progression of the disease and increase your chances of survival. You can actively manage this condition by managing your symptoms, eliminating unhealthy habits, exercising regularly, and eating a healthy diet.

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