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What Is The Prognosis For Stage-4 Heart Failure?

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Posted on Wed, 12 Apr 2017
Question: I'm confused, recent diagnosis of stage 4 heart failure - one dr said it's severe etc and another said don't worrry-?
doctor
Answered by Dr. Sagar Makode (27 minutes later)
Brief Answer:
See the description

Detailed Answer:
Hello,
Stage 4 heart failure is certainly a matter of worry. But issue is that is it a stage 4 heart failure or not.
Usually, patients with this are very symptomatic with shortness of breath at rest, pedal edema, Echo shows severe heart dysfunction, history of heart attacks etc.
So I think for better opinion you should upload your reports like echo, ecg or discharge summary if it's there. So get back with details of your illness.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Sagar Makode (15 minutes later)
I am thinking exact same that how is he stage 4. He is not symptomatic much except sometimes upon exertion . His ejection fraction is 15.

He had bypass surgery 5 years ago following a heart attack. He had heart damage then but was given midication and no follow up.

Obviously it seems to have progressed slowly. There was fluid in lungs and legs
Which they have got rid of .

They have now inserted a icd machine as he has dangerous heart rhythms. And increased the medicine dosage .

doctor
Answered by Dr. Sagar Makode (9 minutes later)
Brief Answer:
It's a stage 3 heart failure

Detailed Answer:
It's a stage 3 heart failure, not 4. So no doubt, ejection fraction of 15 percent indicates severe heart damage, next step is to prevent further damage. So I guess he must be on all medicines for that like antiplatelets aspirin and clopidogrel, statin like Atorvastatin or Rosuvastatin, beta blockers like metoprolol, ace inhibitor like ramipril, diuretics like torsemide and spironolactone. Also, ICD will protect from arrhythmias.
From your side, he should have healthy diet, regular exercises like walking, low salt diet and fluid restriction like water tea coffee juices etc totally less than 1 litre preferably in order to prevent fluid from accumulating in lungs.
Hope this helps you and get back if you have any doubts.
Above answer was peer-reviewed by : Dr. Nagamani Ng
doctor
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Follow up: Dr. Sagar Makode (24 minutes later)
Why here in uk have they said stage 4? The symptom he has is breathless upon exertion . Is that still stage 3? And he had fluid retention
doctor
Answered by Dr. Sagar Makode (1 hour later)
Brief Answer:
Yes

Detailed Answer:
Stage 3 or C includes such patients, while stage 4 includes patients who are not all responding to any medical treatment requiring specialized intervention. This is sometimes difficult to remember, may be that can be the reason for mentioning it as stage 4. You can check this on internet as well as stages of heart failure.

Let me know if I can assist you further.
Regards
Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sagar Makode (39 minutes later)
Well
He has had a icd machine inserted . But i dont get how dr has said that i expect him to be okay for quite some while? He definate is not breathless at rest but does if walks or climbing stairs etc
doctor
Answered by Dr. Sagar Makode (1 hour later)
Brief Answer:
follow-up consultation

Detailed Answer:
The common cause of mortality in such patients is arrhythmias so ICD will protect him from this. Since his ejection fraction is less, doctor probably thought that it might worsen with time and patient will eventually develop severe symptoms.

He gets those symptoms on exertion due to his weakness of heart which leads to fluid accumulation in lungs leading to symptoms. The symptoms on exertion indicate he is in stage 3 at this moment and certainly not in 4.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sagar Makode (17 minutes later)
What is prognosis like for stage 3?
doctor
Answered by Dr. Sagar Makode (42 minutes later)
Brief Answer:
Not very good

Detailed Answer:
Prognosis is not very good with such low ejection fraction. There are various risk scores available like heart failure survival score, XXXXXXX heart failure models etc which can give idea regarding survival.

As I don't know the details regarding BP, BMI, creatinine etc. I put those parameters as normal.
Risk of death is around 20 percent by 1 year and 40-45 percent by 3 years.

Regards


Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sagar Makode (14 minutes later)
Ok i just been told that heart failure is a result of significant cardiomyopathy. At this stage - are symptoms still likely to develop despite medication ?

If medication dont work then prognosis is more poor right?
doctor
Answered by Dr. Sagar Makode (1 hour later)
Brief Answer:
See the description

Detailed Answer:
Symptoms are due to cardiomyopathy, here it is called as ischemic cardiomyopathy. Yes, prognosis is bad when patient doesn't respond to medicine. Patient may have severe symptoms such severe shortness of breath at rest in stage 3 also but here patient will respond to medicine. When patient symptoms are refractory and not responding to medicine, then it is labeled as stage 4.

Hope this helps
Regards

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
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Follow up: Dr. Sagar Makode (37 minutes later)
I see. Do
The tablets hav
doctor
Answered by Dr. Sagar Makode (4 minutes later)
Brief Answer:
Okay, All the best

Detailed Answer:
Okay, All the best..
Is it a question? Sorry I am not able to understand your sentence.

Regards
Note: For further queries related to coronary artery disease and prevention, click here.

Above answer was peer-reviewed by : Dr. Arnab Banerjee
doctor
Answered by
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Dr. Sagar Makode

Cardiologist

Practicing since :2013

Answered : 1867 Questions

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What Is The Prognosis For Stage-4 Heart Failure?

Brief Answer: See the description Detailed Answer: Hello, Stage 4 heart failure is certainly a matter of worry. But issue is that is it a stage 4 heart failure or not. Usually, patients with this are very symptomatic with shortness of breath at rest, pedal edema, Echo shows severe heart dysfunction, history of heart attacks etc. So I think for better opinion you should upload your reports like echo, ecg or discharge summary if it's there. So get back with details of your illness.