THE IMMEDIATE PROGNOSIS OF CONGESTIVE HEART FAILURE

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Abstract
The case histories of 1000 patients with heart failure of the congestive type were studied with the view of determining the factors influential in immediate prognosis. In general the underlying type of heart disease was not of significance in this regard save for cor pulmonale and a small number of patients with heart disease of unknown etiology in both of whom prognosis averaged 10% poorer than for the other groups. The precipitating factors exerted considerable influence, the most favorable outcome occurring in patients with failure precipitated by such factors as tachycardia, respiratory infection, or thyrotoxicosis while failure induced by rheumatic fever, coronary occlusion, or pulmonary infarction was less amenable to treatment. Save for patients under 10 or over 70, in whom prognosis was uniformly bad, age made no striking difference. Patients in the 4th decade did somewhat better than others possibly because auricular fibrillation was present in a larger part of this group. An additional group of 167 patients with coronary occlusion was studied and it was found that hypertensive subjects were more likely to develop failure when coronary occlusion occurred than were normotensives and that therefore, in general, the prognosis was worse. Once failure developed, however, previous or existing hypertension did not affect the outcome. Patients with slight cardiac enlargement usually did well, while increasing cardiac size carried an increasingly poor prognosis although almost a 3d of the patients with very large hearts were able to regain some degree of compensation.

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