Prognosis in general

• The prognosis for heart failure is poor. About 50% of people with heart failure die within 4 years of diagnosis, and about 40% of people admitted to hospital with heart failure die or are readmitted within 1 year [European Society of Cardiology, 2008].
• The prognosis can be difficult to estimate for an individual because [European Society of Cardiology, 2008]:
• Heart failure usually does not evolve gradually, but has stable periods interrupted by episodes of acute destabilization.
• The prognosis depends on the cause of the heart failure, the person's age, comorbidities (such as ischaemic heart disease, hypertension, diabetes, renal dysfunction, chronic obstructive pulmonary disease, and depression), and adherence to treatment.
• Younger people do better, as do people with no other medical problems [National Clinical Guideline Centre for Acute and Chronic Conditions, 2010].
• Two recently published studies suggest that the mortality rate in the UK is improving.
• A population-based UK study found that the 6-month mortality rate for people with heart failure had improved in 2005 (14%) compared with that recorded in 1995 (26%) [Mehta et al, 2009].
• The National UK Heart Failure audit found that hospital inpatient mortality was 11% in 2009 [The NHS Information Centre, 2009]. This is an improvement on the figure from the 2006 Health Commission heart failure survey, in which inpatient mortality was 15% [Nicol et al, 2008].

Prognosis and left ventricular ejection fraction

• The prognosis for people with heart failure and preserved left ventricular ejection fraction is a little better than the prognosis for people with heart failure and reduced ejection fraction [Owan et al, 2006].