How to Live Longer With Congestive Heart Failure

As scary as hearing the words heart failure, also known as congestive heart failure, may seem, it does not have to be a death sentence.

A heart failure diagnosis doesn’t mean your heart has stopped working. It means that your heart is unable to pump enough blood and oxygen to support the other organs in your body, according to the Centers for Disease Control and Prevention (CDC).

“I increasingly see patients who present with significant symptoms and signs of moderate to severe heart failure, and if they get on the various drugs that are now available for heart failure and make lifestyle changes, the disease essentially goes into remission, and they don't notice that they're having it anymore,” says Larry Allen, MD, the interim head of cardiology and medical director of advanced heart failure at the University of Colorado School of Medicine in Aurora.

Congestive heart failure is a type of heart failure that requires prompt medical attention, although sometimes the term is used interchangeably with “heart failure,” according to the American Heart Association (AHA). If you have heart failure, the heart can’t deliver enough blood to the cells. This can cause fatigue, shortness of breath, and coughing, and may limit everyday activities such as walking, climbing stairs, or carrying groceries. Heart failure may also lead to weight gain with swelling in the feet, legs, ankles, or stomach, per the CDC.

The CDC estimates that about 6.2 million adults in the United States live with heart failure. A 2022 American Heart Association report (PDF) showed that heart failure accounted for nearly 10 percent of cardiovascular disease deaths in the United States in 2019.

Life expectancy with congestive heart failure varies depending on the severity of the condition, genetics, age, and other factors. A review of 125 heart failure studies published in 2022 in BMJ indicated that on average, about a quarter of all patients diagnosed with heart failure died within a year. The result matched up fairly closely with a separate paper, published in 2019 in BMJ, based on nearly 60,000 heart failure patients showing that survival rates in patients were 75.9 percent at one year, 45.5 percent at five years, 24.5 percent at 10 years, and 12.7 percent at 15 years.

This research also suggested, however, that outcomes for heart failure patients have been improving over the years. Overall survival rates increased by 6.6 percent between 2000 and 2016. Still, studies have been contradictory. Another paper, published in 2019 in the Journal of the American College of Cardiology, found that heart failure deaths have been climbing since 2012.

The numbers regarding heart failure rates are especially unexpected and concerning among young Americans. According to an investigation published in 2022 in JAMA Cardiology, heart failure climbed among young adults ages 15 to 44 years between 2012 and 2019.

In part, the increase may be due to more young people having risk factors such as obesity and diabetes. “Sadly, we've also seen increasing heart failure related to drug and alcohol use,” says Dr. Allen. “One of the main side effects of stimulants like amphetamines, methamphetamines, and cocaine is heart failure.”

African Americans may be especially at risk for the condition. Analysis from the American College of Cardiology presented in 2020 revealed that African American women have a higher prevalence of heart failure than any other intersection of race and sex in the United States. African Americans of both sexes are disproportionately dying from heart failure compared with other races and ethnicities, particularly among younger age groups.

Can You Get Better After a Diagnosis of Heart Failure?

Despite the gloomy data, Allen maintains that there are reasons for heart failure patients to be optimistic. “Thirty years ago there weren't a lot of medicines to actually make the heart work better,” he says. “What we've seen over the last three decades is the development of a variety of classes of drugs that actually do improve heart function and slow progression of the disease. The patients are not cured because they have to keep up with daily drugs and healthy behaviors, but we see a large number of people now who really have pretty remarkable recoveries.”

So although there is no absolute cure for heart failure, medication and lifestyle changes can prevent the condition from worsening and in certain cases, return almost regular heart function.

Causes and Risk Factors for Heart Failure

The most common conditions that can weaken the heart enough to lead to heart failure include coronary artery disease, high blood pressure, and previous heart attack, notes the AHA.

Lifestyle factors such as smoking, being overweight, eating foods high in fat and cholesterol, and physical inactivity can also contribute to heart failure.

Other conditions that can lead to heart failure include:

• Abnormal heart valves
• Damage to the heart muscle (cardiomyopathy)
• Inflammation of the heart muscle (myocarditis)
• Congenital heart defects
• Severe lung disease
• Diabetes
• Obesity
• Sleep apnea

Less common temporary causes of heart failure include severe anemia, hyperthyroidism, and abnormal heart rhythm (arrhythmia or dysrhythmia).

Stages of Congestive Heart Failure

Regardless of the "stage" of heart failure, it is a chronic, progressive heart health condition that can worsen over time, per the AHA. The sooner you begin making lifestyle changes to treat the condition, the better chance you have at improving your outcome.

In order to improve life expectancy while living with congestive heart failure, you should know the different stages of the disease and what to do after diagnosis.

Depending on the stage and severity of the condition, some individuals may need more aggressive treatment, but it is very possible to live a very good life with a diagnosis of heart failure, according to Allen.

Stage A

This is “pre–heart failure,” according to the Cleveland Clinic. It means you’re at risk of developing heart failure because you have a family history of heart failure, or because you have diabetes, high blood pressure (hypertension), coronary artery disease, or there's a family history of cardiomyopathy, a disease of the heart muscle. A person with a higher likelihood of heart failure may also have a history of rheumatic fever, alcohol abuse, or taking drugs that can damage heart muscle (including certain cancer drugs).

“One of the first things I think about and for patients with heart failure is what can we do to either prevent or stop the underlying cause of what's making the heart not work as well,” says Allen. “I generally would say most hearts are probably better off if the underlying causes of heart failure are addressed as early as possible.”

He adds that if problems are left unaddressed for too long, the damage becomes permanent.

Treatment may include a low-sodium diet (along with other treatments and medications for high blood pressure), not drinking alcohol, increasing exercise, not smoking, treating high cholesterol, and taking medications for coronary artery disease, diabetes, or other vascular or cardiac conditions, per the Cleveland Clinic.

Stage B

This diagnosis is also considered pre–heart failure. In this stage, you have no symptoms or signs of heart failure, but you already have some changes to the heart that could possibly lead to heart failure. The Cleveland Clinic says most people with stage B heart failure have an echocardiogram (echo) that shows an ejection fraction (EF) of 40 percent or less. Ejection fraction is a measure of how much blood the left ventricle pumps out with each contraction.

“At this stage, I could start to see some mild abnormalities of the heart, but a patient might not easily recognize that the heart function is abnormal,” says Allen.

Treatments could include those from stage A, as well as taking a beta-blocker if you’ve had a heart attack and your EF is 40 percent or lower (if you aren't already taking one), taking an aldosterone antagonist if you’ve had a heart attack or if you have diabetes and an EF of 35 percent or less, and possible surgery or intervention as treatment for coronary artery blockage, heart attack, or valve disease, or congenital heart disease, notes the Cleveland Clinic.

Stage C

Individuals at this stage have been diagnosed with heart failure, and currently have or have previously had signs and symptoms of the condition, including shortness of breath, fatigue, reduced ability to exercise, weak legs, or waking up to urinate, and swollen feet, ankles, lower legs and abdomen, according to the Cleveland Clinic.

“At this stage, a person’s functional abilities and way that they feel are significantly affected,” says Allen.

With good regimens of medication, people with stage C heart failure can have a good, long quality of life.

Treatments include those for stage A and stage B, along with hydralazine-nitrate combination if other treatments don't stop your symptoms, medications that slow your heart rate if your heart rate is faster than 70 beats per minute and you still have symptoms, diuretics and dietary salt or fluid restriction, possible cardiac resynchronization therapy (biventricular pacemaker), and possible implantable cardiac defibrillator (lCD) therapy, per the Cleveland Clinic.

Stage D

This is an advanced stage of heart failure, and these patients are the sickest. “Unfortunately, many of the causes of end-stage heart failure are not reversible or fixable,” says Allen. “It is a common cause of death but not in everyone. In younger patients with end-stage heart failure who do not have other health problems, they may benefit from heart transplantation or even artificial hearts such as left ventricular assist devices.”

Patients with this stage of heart failure should see a specialist to help determine the best course of treatment and which options are still on the table.

Seeking out a specialist may present more treatment options for individuals diagnosed with any stage of heart failure. Bringing a list of questions to the appointment, as well as a list of your medication, and a supportive family member. Oftentimes a family member may have noticed symptoms of fatigue or shortness of breath that the patient is unaware of.

Living With Congestive Heart Failure: What to Expect

Yes, there are several lifestyle changes you should take into account if you’ve been diagnosed with congestive heart failure. But remember your diagnosis doesn’t mean you should necessarily stop doing things you love.

Exercising — walking, biking, swimming, or doing light weight exercises — can benefit the heart. The AHA recommends that all adults get at least 150 minutes of moderate intensity aerobic activity every week for optimal heart health. Make sure to talk to your doctor before starting a new exercise routine.

Your doctor may also suggest making heart-healthy dietary changes, reducing how much fluid you drink to reduce your body’s water content, or taking diuretics (water pills) to decrease your heart’s workload, per the AHA.

Other lifestyle changes that can slow the progression of heart failure include:

• Quitting smoking
• Avoiding or limiting alcohol
• Losing weight or maintaining a healthy weight
• Getting adequate sleep
• Controlling high blood pressure
• Reducing stress
• Joining a support group
• Staying up to date on flu and pneumonia vaccinations

Medications for Heart Failure

A variety of medications may be prescribed for heart failure, according to the AHA. These include angiotensin-converting enzyme inhibitors (ACE inhibitors), angiotensin 2 receptor blockers, angiotensin-receptor neprilysin inhibitors (ARNIs), If channel blockers, beta-blockers, aldosterone antagonists, and hydralazine and isosorbide dinitrate (a combination drug). Other drugs may be prescribed to reduce symptoms, such as diuretics, anticoagulants (blood thinners), cholesterol-lowering statins, and digoxin.

If being on medication leads to an improvement of symptoms and your health, your doctor might advise you to stay on them for good, as they may help prolong your life.

“Often if drugs are taken early and in greater combination, they're likely to be more successful at preventing the progression of heart failure,” says Allen. “With good treatment and ongoing management, a lot of people can largely put their heart failure at the back of their mind, which speaks to all the advances that have been made.”