what is prognosis

[agb719]

My father has had atrial fibrillation for many years.  He is now 76 y/o and recently had echocardiogram and chemical stress test.  His hgb level was 7 and they gave him 2 units of blood a month ago.  The echo and stress show major part of heart not getting blood flow, main coronary arter has large blockage, two leaky valves.  EF factor of 34% and creatinine level of 2.3 with 30% functioning of kidneys.  They say this is due to lack of blood flow. Also, his short term memory is completely gone.  I had just seen him 3 months ago and he was a little forgetful but not like this.  He refuses any treatment because he spent 12 weeks in hospital last year for osteomyelitis of the foot from his peripheral artery disease.  He is now on a walker and incontinent from enlarged prostate.  He also refuses any tests to see where bleeding that caused hgb level to be so low is coming from. What do you feel the prognosis is?  His cardiologist referred him to hospice care since he refuses treatment.  The hospice nurse comes once a week to check on him.  

[Cleveland Clinic]

The anemia must be treated and worked up.  If related to the heart or to the kidney insufficinecy, it will likely get better once those two improve.  It sounds like it is the heart that is causing all the problems and it needs to be treated accordingly.  First with medications, then with likely surgery or percutaneous inteventions.  Either way, I would recommend getting a second opinion and a likely transfer to a tertiary care center.  The prognosis all depends on his functional level and the degree of cardiac dysfunction.  If he had silent heart attacks then there will be very little that can be done, on the other hand, if the heart is ischemic (low blood flow) or in a hybernating state, the prognosis is relatively good.  Again, having an experienced cardiologist and a surgeon will be key.