Prognosis in heart failure can be assessed in multiple ways including clinical prediction rules and cardiopulmonary exercise testing. Clinical prediction rules use a composite of clinical factors such as lab tests and blood pressure to estimate prognosis. Among several clinical prediction rules for prognosing acute heart failure, the 'EFFECT rule' slightly outperformed other rules in stratifying patients and identifying those at low risk of death during hospitalization or within 30 days. Easy methods for identifying low risk patients are:
* ADHERE Tree rule indicates that patients with blood urea nitrogen < 43 mg/dl and systolic blood pressure at least 115 mm Hg have less than 10% chance of inpatient death or complications.
* BWH rule indicates that patients with systolic blood pressure over 90 mm Hg, respiratory rate of 30 or less breaths per minute, serum sodium over 135 mmol/L, no new ST-T wave changes have less than 10% chance of inpatient death or complications.
A very important method for assessing prognosis in advanced heart failure patients is cardiopulmonary exercise testing (CPX testing). CPX testing is usually required prior to heart transplantation as an indicator of prognosis. Cardiopulmonary exercise testing involves measurement of exhaled oxygen and carbon dioxide during exercise. The peak oxygen consumption (VO2 max) is used as an indicator of prognosis. As a general rule, a VO2 max less than 12-14 cc/kg/min indicates a poorer survival and suggests that the patient may be a candidate for a heart transplant. Patients with a VO2 max 35 from the CPX test. The heart failure survival score is a score calculated using a combination of clinical predictors and the VO2 max from the cardiopulmonary exercise test.
Average or poor prognosis have been observed in many patients,almost 10% mortality rate with mild symptoms to over 50% in patients with advanced,progressive symptoms.Cause for mortality in patients with Congestive heart failure seems to be developing like-severe leftventricular dysfunction,severe symptoms and limitation of exercise capacity with minimal Oxygen consumption <10mL/Kg/min,secondary renal insufficiency, hyponatremia, elevated plasma catecholamine levels.40 to 50 % with ventricular arrhythmias,non sustainable ventricular tachycardia seems to show hiw mortality with a sudden death.
Based on this mortality rate report its very hard to tell what category your father falls in.Learning the case personally and observing his presenting symptoms at a given time would reveal his hidden problem leading him to attend hospital many times.Patients with CHF mostly present with symptoms like acute nocturnal paroxysmal dyspnea,nocturia,electrolyte changes,pulmunary and peripheral edema,embolism,,arrhythmias,didgitalis toxicity and a lot more basing on presence and severity of the disease in right or left side of the heart.So observe your father and let me know about more details.Talk to your doc regarding medications and their ability to cure reversible changes in disease as many patients show poor prognosis because of frequent switching in medication and treatment modalities.Keep me updated.
I hope you will feel better about things after some research.
Here is a very useful site - where you can look up practically anything.
When I was diagnosed with Congestive Heart Failure [CHF] [now more commonly referred to as Heart Failure] [HF] in 2003 - I went online to reasearch this disease. I read that 5 million Americans have it and that 50% die - 5 years after being diagnosed. Well - this year is 2 years past that dreaded 5 years and it is only possible that I am alive because of medication and lifestyle changes. I'm 58 - and was diagnosed when I was 52.
But for more scientific information - I give you the following links and Data. I happen to be researching Heart Assist Devices" - as I may need one and I am going through the testing in the very near future to see if I qualify in a Heart Transplant program in Boston, Mass.
Heart-assist devices can help extend lives
Globally, heart failure (HF) is on the rise in contrast to other cardiovascular disorders. Approximately 23 million people worldwide are living with HF, and in the 3 years from 2002 to 2004, the incidence of new cases nearly tripled from 2 million to 5.7 million cases (Kalorama Information, 2002; World Health Organization, 2004). Although transplantation remains the "gold standard" treatment for advanced HF, this option is not available for many patients. There are not enough donor hearts available to meet the number of patients waiting for transplant, and there are increasing numbers of HF patients who do not qualify as candidates for heart transplantation. As a result, surgical implantation of a left-ventricular assist device (LVAD) is becoming increasingly prevalent as both a "bridge" to heart transplant and an alternative to transplant, referred to as "destination therapy." Regardless of the rationale for the device, implantation of an LVAD gives rise to a new, complex set of self-care demands that patients must meet to ensure their safety and health. HF patients learning to live with an LVAD require nursing assistance to meet these new demands. Unfortunately, to date, the majority of information on LVADs found in nursing journals is generally derived from other disciplines such as medicine, engineering, epidemiology, and psychology. Thus, the current body of knowledge lacks a nursing perspective to guide the scope of nursing practice in this patient population.
FOUNDATIONAL KNOWLEDGE: THE PROBLEM OF HF
HF is defined as a "complex clinical syndrome that can result from any structural or functional cardiac disorder that impairs the ability of the ventricle to fill with or eject blood" (Hunt et al,2005, p. 1828). The disease manifests with structural and functional changes, including left-ventricular hypertrophy, pulmonary congestion, peripheral edema, dyspnea, fatigue, and activity intolerance, all of which negatively affect the person's quality of life (Goodlin et al.,2004). The commonly identified causes of HF include coronary artery disease, hypertension, and cardiac dysrhythmias (Woods, Froelicher, Motzer, & Bridges,2005). Despite the emphasis in cardiovascular disease prevention over the years, the worldwide epidemic of HF continues to expand because of the aging population and rising incidence and prevalence of HF risk factors such as diabetes, obesity, and cardiomyopathy (Boyle,2009; Hunt et al.,2005).
Best wishes and don't hesitate to write if you have further concerns and questions.