Congestive heart failure natural history, complications & prognosis

Associate Editor-In-Chief: ; Saleh El Dassouki, M.D [mailto:seldassouki@hotmail.com], Atif Mohammad, MD

Complications
1. Cardiac Arrhythmias:
 * Ventricular tachycardia and ventricular fibrillation can occur as serious complications of heart failure when its pump function is severely impaired. This further worsens the cardiac output and even possible death.
 * Atrial fibrillation which is rapid beating of atrium without optimal forward pumping of blood is another complication of heart failure which occurs as a result of resistance to blood flow from atrium to ventricles. These patients are at increased risk of stroke.
 * Left bundle branch block is an abnormality in electrical conduction in the heart.

2. Congestion:
 * Pulmonary congestion which occur in left ventricular failure can cause pulmonary edema.
 * Venous stasis and pedal edema can occur as a complication of right heart failure. These conditions predispose patients to venous ulcers, infections and cellulites.
 * Cardiac cirrhosis occurs as a result of hepatic venous congestion. This can lead to coma and even death.

3. Angina and myocardial infarction: Cardiac ischemia and infarction can also occur when heart failure patients undergo exertion.

4. Renal failure: Renal impairment can occur secondary to decreased renal perfusion. This further worsens heart failure by fluid retention.

5. Cardiac cachexia: Unintentional rapid weight loss (a loss of at least 7.5% of normal weight within 6 months) can occur in chronic heart failure. This is a bad prognostic factor.

Mortality Associated with Heart Failure
Based on the 44-year follow-up of the NHLBI’s Framingham Heart Study:
 * 80% of men and 70% of women under age 65 who have heart failure will die within following 8 years.
 * In people diagnosed with heart failure, sudden cardiac death occurs at 6 to 9 times the rate of the general population.
 * One in eight deaths has heart failure mentioned on the death certificate.

Hospital Discharges

 * Hospital discharges for heart failure rose from 400,000 in 1979 to 1,084,000 in 2005, an increase of 171%. (NHDS / NHLBI and AHA calculations).