By Rebeca Schiller 

 Medically reviewed by Jeffrey S. Lander, MD

 Fact checked by Nick Blackmer

Congestive heart failure (CHF) occurs when the heart can’t pump enough blood out to the body. Despite advances in treatment, the outlook for people with CHF is generally poor. The survival rate of a person with CHF depends on how the well the heart functions, their age and CHF stage, whether they have other diseases, and more.

A number of heart-related health conditions can contribute to CHF. They include coronary artery disease, high blood pressure, cardiac arrhythmia, or a previous heart attack.

This article explains the factors that may affect outcomes for people who are living with CHF. It talks about steps you can take to reduce some of the risk factors that can lead to poor outcomes.

Overall Survival

CHF is a chronic and progressive condition. It weakens the heart, which then is unable to pump enough blood. It limits the heart’s ability to deliver the oxygen and nutrients needed for the cells in your body to function.1

There are two main types of heart failure. The first is heart failure with reduced ejection fraction, also known as systolic heart failure. In this case, the heart muscle itself is weak and cannot adequately pump blood to the rest of the body.1

The second main type is called heart failure with preserved ejection fraction, or diastolic heart failure. Here, the heart muscle is stiff rather than weak. This makes it hard for the heart to fill with blood.

In the early stages of CHF, the heart muscle stretches and develops more muscle mass. These changes allow it to contract (squeeze) with more force to pump more blood. But over time, the heart enlarges. It can no longer manage its workload. This will lead to symptoms that include:2

• Fatigue

• Shortness of breath

• Increased heart rate

• Swelling (edema) in the legs

CHF is broken down into four stages. They range from an initial high risk of developing heart failure to advanced heart failure.3 As the symptoms get worse, so does the stage of CHF.

The prognosis for CHF is based on five-year mortality (death) rates. This measure is used to estimate short- and long-term survival rates from the time that your CHF is diagnosed and treatment begins.4

About 6.7 million adults in the United States have been diagnosed with heart failure. In 2020, heart failure was listed as the underlying cause of 85,855 deaths.5 It is widespread in some U.S. regions, primarily the South and Midwest.6

A review published in 2017 looked at people with CHF who were either treated in the community or as outpatients in a cardiology clinic. The study found the average CHF survival rates were:4

• 80–90% after one year, compared to 97% in the general population

• 50–60% by the fifth year, compared to 85% in the general population

• 27% by year 10, compared to 75% in the general population

Recap

Congestive heart failure is a condition that can make the heart too weak or too stiff to pump blood properly. This means the rest of the body does not get the oxygen and nutrients it needs. Ejection fraction is a measure of this pumping force in the left ventricle of the heart. If it is preserved, then the type of CHF is called diastolic heart failure. If it is reduced, this is known as systolic heart failure.

Prognosis by Stage

Prognosis depends on the stage and cause of CHF, as well as age, sex, and socioeconomic status. Stages of CHF range from A to D.3

• Stage A: High risk for heart failure, but without symptoms or structural heart disease

• Stage B: Structural heart disease, but without signs or symptoms of heart failure (also known as pre-heart failure)

• Stage C: Structural heart disease with prior or current symptoms of heart failure

• Stage D: Advanced heart failure characterized by recurrent hospitalizations despite attempts to optimize treatment

The table below shows five-year mortality data for each of the four stages of CHF.7

Factors Affecting Survival

Some factors that may affect a person’s survival rate include age, sex, exercise tolerance, and other medical conditions.

Age

Heart failure typically affects older adults (middle-aged and older). Research by analysts at the Centers for Medicare & Medicaid Services found that among patients eligible for Medicare or Medicaid, it was the leading cause of potentially avoidable hospitalization.8 Complications of CHF also rise steadily with age.

One clinical trial looked at hospitalization rates for different age groups, from age 20 through age 65 and older. It found the death rates were lower for patients in the 20–44 age group. They were less likely to be admitted to the emergency room or hospitalized for heart failure or other cardiac issues.9

However, death rates were still significant for people younger than 44 after 30 days (3.9%), one year (12.4%), and five years (27.7%). The study found that serious CHF episodes were more frequent in half of the people who were readmitted to the hospital. Two-thirds of them went to emergency rooms, and more than 10% died within a year.

Sex

Women with CHF tend to live longer than men when the cause isn’t ischemia, an inadequate blood supply to the heart muscles. In fact, women with this type of heart failure have a better chance of surviving than men, either with or without heart disease as their main cause of heart failure.10

Other health issues that affect survival in women with heart failure, especially after menopause, include:

• High blood pressure

• Heart valve conditions

• Diabetes

• Coronary artery disease

Once coronary heart disease has been diagnosed, the risk of CHF increases. 

Exercise Tolerance

CHF symptoms include labored breathing and fatigue. Low exercise tolerance also is a key symptom in CHF. It is associated with poor quality of life and an increased mortality rate.11

Exercise intolerance means there is a reduced and limited amount of oxygen that a person can use during an intense workout. It also means that you have a limited ability to carry out any physical activity. The capacity of your heart and lungs are key contributors.

Other factors, such as anemia, obesity, and any muscle or bone disorders, also play a role in your overall exercise tolerance. 

The three-year survival rate for people living with CHF who have a reduced exercise tolerance is 64%. This compares with 97% in those with normal exercise tolerance.12

Ejection Fraction

The heart has four chambers: the right atrium and ventricle, and the left atrium and ventricle. The left ventricle forces blood out into the body. Ejection fraction measures the percentage of blood that is pumped out by the left ventricle each time the heart contracts.

The quality of this function is used to classify different types of heart failure. If the ejection fraction is normal, this is called heart failure with preserved ejection fraction. If the ejection fraction is diminished, this is called heart failure with reduced ejection fraction.

• Preserved ejection fraction (HFpEF), or diastolic heart failure: The heart contracts normally but the ventricles do not relax as the ventricle fills with blood.

• Reduced ejection fraction (HFrEF), or systolic heart failure: The heart does not contract properly. This leads to less oxygen-rich blood being pumped out to the body.

Normal ejection fraction rates range between 50% and 70%. Function is considered borderline when it falls between 41% and 49%. This doesn’t always mean that a person is developing heart failure, but it may be a sign of heart damage or a prior heart attack. An ejection fraction rate of 40% or lower may indicate heart failure or cardiomyopathy.  

Death rates for people with diastolic heart failure are lower compared to people who have systolic heart failure. One study, with a mean follow-up of 37 months, showed the mortality rate increased in proportion to any decrease in left ventricular ejection fraction (LVEF). The results were:13

Diabetes

Type 2 diabetes is a factor that increases the risk of poor outcomes in people with CHF. Research has found that people with diabetes are two to four times more likely to develop CHF than people without diabetes. As many as 47% of people with heart failure also have diabetes. And many people with CHF have diabetes that has gone undetected and not been diagnosed.14

A study of 150 people with heart failure assessed them for previously undiagnosed prediabetes and type 2 diabetes. Of this group, 43% were found to have prediabetes, and 19% had diabetes.15

During two years of follow-up, compared to the people without prediabetes or diabetes, those with prediabetes were 2.6 times more likely to die of any cause, and almost three times as likely to die of cardiovascular causes, such as heart attack, stroke, or worsening heart failure. People with diabetes were more than five times as likely to die of any cause, and almost 10 times as likely to die of cardiovascular causes.15

Hospitalization

Heart failure that requires hospitalization is associated with poor outcomes. People who have multiple hospitalizations often have other serious medical conditions and are at greater risk of death, particularly death from cardiovascular causes.16 

Recap

Many factors affect the survival of CHF patients. Your age, sex, and even your physical ability to exercise all contribute to your possible outcomes. The type and stage of your CHF also matter. So do the heart-related and other health conditions you may have along with CHF. One of the most significant risk factors is diabetes. For this reason, people with both diabetes and heart failure often are treated by heart specialists.

What You Can Do

Some risk factors of heart failure, like age, can’t be modified. Still, people with CHF can take steps to improve the long-term prognosis. The first thing to do is to be familiar with any family history of heart disease. You’ll also want to learn about all the possible symptoms. Don’t ignore any symptom that you think is cause for concern. Tell your healthcare provider about them right away.

Regular exercise, along with managing any other health issues you may have, can also help to keep CHF under control.

Exercise

If you are diagnosed with heart disease, then weight loss alone does not lower your mortality risk. Yet ongoing and sustained physical activity is associated with some risk reduction.

An analysis of data from the Heart Failure Adherence and Retention Trial compared people with heart failure who engaged in 150 or more minutes a week of moderate activity or 75 or more minutes a week of vigorous activity (the “ideal” group) with those who got less (“intermediate”) or no moderate or vigorous activity (“poor”).17

In the 2.4 years of follow-up, compared to the ideal group, the other groups were almost twice as likely to be hospitalized, and more than four times as likely to die of cardiovascular causes. The intermediate group was twice as likely to die of any cause, and the poor group was almost three times as likely to die of any cause.17

A 2018 study published in the Current Obesity Reports suggests that a sustained weight loss of more than 5% of total body weight will lead to better control over blood sugar levels and lower the risk of heart-related factors.18 Healthy lifestyle choices, including diet and exercise, can help. So can medication or surgery to manage weight. Be sure to talk to your healthcare provider before you begin any sort of weight-loss program.

Diabetes Control

Diabetes has been linked to the risk of heart failure. Among people with diabetes, 25% have chronic heart failure and up to 40% have acute heart failure.19 For this reason, people with both diabetes and heart failure are treated by cardiologists (heart specialists). To reduce the risk of death, good blood sugar control is key.

Angiotensin-converting enzyme (or ACE) inhibitors are often used to help treat both type 1 and type 2 diabetes with heart failure. ACE inhibitors offer a number of benefits, and are linked with a lower death rate and fewer hospitalizations. Angiotensin II receptor blockers, or ARBs, have shown similar benefits in heart failure patients with and without diabetes.

Medications

In heart failure with reduced ejection fraction, a few drugs have been shown to reduce deaths and hospitalizations. Healthcare providers may prescribe the following medications in some combination:3

• Beta-blockers (carvedilol, metoprolol succinate, or bisoprolol)

• Entresto (sacubitril with valsartan)

• An ARB or ACE inhibitor

• Spironolactone

• Sodium glucose co-transporter 2 (SGLT2) inhibitors

• Ivabradine

In heart failure with preserved ejection fraction, no medications have been shown to improve mortality except diuretics.20 There is some evidence that spironolactone may also offer a benefit.21

Heart failure prognosis has improved due to new drug therapies. Still, how effective these drugs are can change over time. Tell your cardiologist about any new symptoms, or those that get worse. They can evaluate you for possible changes in your treatment. 

Summary

The left ventricle is the chamber of the heart that forces blood out into the body. When it no longer works properly, the amount of blood it forces out into the body is not adequate for its needs.

This can happen because the heart muscle is too weak, causing what’s called a reduced ejection fraction. It also can happen due to the muscle becoming stiff and unable to relax, as is the case with preserved ejection fraction.

These fractions are used to measure how well your heart is working. Along with other factors, such as age or additional health problems, they contribute to an assessment of how serious or advanced your CHF has become. This helps healthcare providers to offer you the most accurate estimates possible when it comes to your disease progression and your life expectancy.

 Sources

American Heart Association. Types of heart failure.

Johns Hopkins Medicine. Heart failure.

Heidenreich P, Bozkurt B, Aguilar D, et al. 2022 AHA/ACC/HFSA guideline for the management of heart failure. J Am Coll Cardiol. 2022;79(17):e263–e421. doi:10.1016/j.jacc.2021.12.012

Jones NR, Hobbs FR, Taylor CJ. Prognosis following a diagnosis of heart failure and the role of primary care: a review of the literature. BJGP Open. 2017;1(3). doi:10.3399/bjgpopen17X101013

Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics—2023 update: a report from the American Heart Association. Circulation. 2023;147(8):e93-e621. doi:10.1161/CIR.0000000000001123

Glynn PA, Molsberry R, Harrington K, et al. Geographic variation in trends and disparities in heart failure mortality in the United States, 1999 to 2017. J Am Heart Assoc. 2021;10(9):e020541. doi:10.1161/JAHA.120.020541

Echouffo-Tcheugui JB, Erqou S, Butler J, Yancy CW, Fonarow GC. Assessing the risk of progression from asymptomatic left ventricular dysfunction to overt heart failure: a systematic overview and meta-analysis. JACC Heart Fail. 2016;4(4):237-248. doi:10.1016/j.jchf.2015.09.015

Segal M, Rollins E, Hodges K, Roozeboom M. Medicare-Medicaid eligible beneficiaries and potentially avoidable hospitalizations. Medicare Medicaid Res Rev. 2014;4(1):mmrr.004.01.b01. doi:10.5600/mmrr.004.01.b01

Wong CM, Hawkins NM, Ezekowitz JA, et al. Heart failure in young adults is associated with high mortality: a contemporary population-level analysis. Can J Cardiol. 2017;33(11):1472-1477. doi:10.1016/j.cjca.2017.05.009

Taylor CJ, Ordóñez‐Mena JM, Jones NR, et al. National trends in heart failure mortality in men and women, United Kingdom, 2000–2017. Eur J Heart Fail. 2021;23(1):3-12. doi:10.1002/ejhf.1996

Morris JH, Chen L. Exercise training and heart failure: a review of the literature. Card Fail Rev. 2019;5(1):57-61. doi:10.15420/cfr.2018.31.1

Malhotra R, Bakken K, D'Elia E, Lewis GD. Cardiopulmonary exercise testing in heart failure. JACC Heart Fail. 2016;4(8):607-616. doi:10.1016/j.jchf.2016.03.022

Curtis JP, Sokol SI, Wang Y, et al. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. Journal of the American College of Cardiology. 2003;42(4):736-742. doi:10.1016/s0735-1097(03)00789-7

Bavishi A, Patel RB. Addressing comorbidities in heart failure: hypertension, atrial fibrillation, and diabetes. Heart Fail Clin. 2020;16(4):441-456. doi:10.1016/j.hfc.2020.06.005

Pavlović A, Polovina M, Ristić A, et al. Long-term mortality is increased in patients with undetected prediabetes and type-2 diabetes hospitalized for worsening heart failure and reduced ejection fraction. Eur J Prev Cardiol. 2019;26(1):72-82. doi:10.1177/2047487318807767

Lahoz R, Fagan A, McSharry M, Proudfoot C, Corda S, Studer R. Recurrent heart failure hospitalizations are associated with increased cardiovascular mortality in patients with heart failure in Clinical Practice Research Datalink. ESC Heart Fail. 2020;7(4):1688-1699. doi:10.1002/ehf2.12727

Hegde SM, Claggett B, Shah AM, et al. Physical activity and prognosis in the TOPCAT trial (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist). Circulation. 2017;136(11):982-992. doi:10.1161/CIRCULATIONAHA.117.028002

Ryan DH, Yockey SR. Weight loss and improvement in comorbidity: differences at 5%, 10%, 15%, and over. Curr Obes Rep. 2017;6(2):187-194. doi:10.1007/s13679-017-0262-y

Rosano GM, Vitale C, Seferovic P. Heart failure in patients with diabetes mellitus. Card Fail Rev. 2017;3(1):52-55. doi:10.15420/cfr.2016:20:2

Gazewood JD, Turner PL. Heart failure with preserved ejection fraction: Diagnosis and management. Am Fam Physician. 2017;96(9):582-588.

Selvaraj S, Claggett B, Shah SJ, et al. Utility of the cardiovascular physical examination and impact of spironolactone in heart failure with preserved ejection fraction. Circ Heart Fail. 2019;12(7):e006125. doi:10.1161/CIRCHEARTFAILURE.119.006125

By Rebeca Schiller
Rebeca Schiller is a health and wellness writer with over a decade of experience covering topics including digestive health, pain management, and holistic nutrition.