Congestive Heart Failure

Description

Alternative Names

Complications

At least 20% of hospitalizations in older adults are due to heart failure. For people over 65, it is the number one cause of death, with nearly 290,000 people dying from this disease each year. Nevertheless, although heart failure produces very high mortality rates, treatment advances in hypertension, heart surgeries, and heart pacemakers are now improving survival rates in patients with severe heart failure.

Life-Threatening Complications of Heart Failure

The most serious and life-threatening complications of heart failure are the following:

• Arrhythmias (irregular beatings of the heart).
• Acute pulmonary edema (fluid in the lungs).

Conditions Associated with Left-Side Heart Failure and Their Effect on Severity

Left-side heart failure tends to be more severe than right-side heart failure, particularly when it is associated with the following conditions:

• Coronary artery disease.
• HIV infection.
• Amyloidosis.
• Chemotherapy with doxorubicin.

The outlook is better in patients with left-side heart failure associated with the following:

• Idiopathic cardiomyopathy (the cause is unknown).
• Heart failure due to childbirth.

Other Conditions Associated with Increased Severity in Heart Failure

Weight Issues. If heart failure patients are overweight to begin with, their condition tends to be more severe. Once heart failure develops, however, an important indicator of a worsening condition is the occurrence of cardiac cachexia, which is unintentional rapid weight loss (a loss of at least 7.5% of normal weight within six months).

Impaired Kidney Function. In one study of patients with advanced heart failure, impaired kidney function was the most important indicator for a poor outlook, even more so than heart function itself. (In the study, impaired kidney function was not associated with heart failure.)

Congestion (Fluid Buildup). According to one study, patients with severe symptoms who have congestion (fluid buildup) have poorer survival rates than those without fluid build up. In fact, two-year survival rates are 87% in those who were congestion-free compared to 41% to 67% in patients with various signs of congestion (e.g., swelling, difficulty breathing when lying down, weight gain from fluid buildup).

Atrial Fibrillation. This abnormal rhythm is a rapid quivering beat in the upper chambers of the heart. It is a major cause of stroke and very dangerous in people with heart failure.

Left Bundle Branch Block. Left bundle-branch block is an abnormality in electrical conduction in the heart. It develops in about 30% of heart failure patients and is a major risk factor for serious adverse heart events.

Sleep Apnea. With this disorder a person stops breathing during the night, perhaps hundreds of times, usually for periods of 10 seconds or longer. It is a very strong risk factor for heart failure, and patients with apnea have a higher mortality rate than those without it.

Depression. The presence of depression indicates a poorer outlook. Studies indicate that depression may have adverse biologic effects on the immune and nervous systems, blood clotting, blood pressure, blood vessels, and heart rhythms.

Seasonal and Daily Patterns. More emergency room visits and higher mortality rates have been observed during winter months and on Mondays in patients with heart failure. One factor in this higher risk may be sudden and strenuous exertion, particularly snow-shoveling, which is associated with a risk for heart attack in people with heart problems.