The prognosis of Dilated Cardiomyopathy
(DCM) is usually uncertain, and most patients will eventually develop chronic heart failure. The prognosis of dilated cardiomyopathy is generally poor, despite advances in current treatment options. Specifically, the mortality rate can be around 20% in the first year and 10% annually thereafter; about 40 to 50% are sudden deaths due to malignant arrhythmic or embolic events. Women have a better prognosis than men, and people of African descent survive about half as long as whites.
The
prognostic factors include the severity of heart failure, renal failure, and the thickness of the ventricular wall. If compensatory hypertrophy preserves the thickness of the ventricular wall, the prognosis is better, while significant thinning of the ventricular wall and ventricular dilatation have a worse prognosis. Patients with well-compensated dilated cardiomyopathy after treatment may remain stable for many years.
In addition, the prognosis of dilated cardiomyopathy depends on the cause, such as infection (viruses are common), toxins, metabolic, genetic factors, or connective tissue disease. Advances in treatment, Uch as beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARBs), angiotensin II receptor blockers and enkephalin inhibitors (ARNI), mineralocorticoid receptor antagonists, sodium glucose cotransporter 2 (SGLT2) inhibitors, Implantable cardioverter defibrillators or cardiac resynchronization therapy have also played a role in improving the prognosis of patients.
To sum up, the prognosis of dilated cardiomyopathy is affected by many factors, including the severity of the disease, etiology, treatment and so on. Although the prognosis is generally poor, with the progress of treatment methods, the prognosis of patients with active cooperation and regular treatment has been significantly improved.
Here are some ways to improve quality of life in patients with dilated cardiomyopathy:
1. Prevention and treatment of heart failure: Diuretics and vasodilators should be used according to the hemodynamic status of patients. Angiotensin-converting enzyme inhibitors (ACEI) can be used in almost all patients, and these drugs can inhibit myocardial remodeling and improve prognosis. Long-term use of beta-blockers in the treatment of dilated cardiomyopathy can prevent the deterioration of the disease, improve clinical signs and symptoms and left ventricular function, reduce mortality and improve the prognosis.
2. Prevention of thrombosis and embolic complications: For patients with atrial fibrillation, long-term treatment with anticoagulants can be considered in addition to contraindications. Commonly used drugs are warfarin, or new anticoagulants such as dabigatran and rivaroxaban.
3. Antiarrhythmic therapy: For patients with arrhythmias, antiarrhythmic drugs or implantable cardioverter defibrillators (ICDs) may be required.
4. Cardiac resynchronization therapy (CRT): For patients with cardiac dyssynchrony, CRT can improve the efficiency of cardiac output, and long-term application can reverse myocardial remodeling and reduce heart failure hospitalization and mortality.
5. Lifestyle adjustment: including paying attention to rest and avoiding fatigue, limiting physical exercise, low-salt diet, preventing infection, so as to avoid deterioration of the disease.
6. Cardiac rehabilitation: Cardiac rehabilitation can reduce mortality, relieve symptoms and reduce adverse cardiac events.
7. Dietary education: All patients with dilated cardiomyopathy need dietary education, including salt and water restriction, to reduce the preload of the heart.
8. Regular follow-up: Patient education about medication compliance, dietary restrictions, and regular follow-up is essential for the management of dilated cardiomyopathy.
9. Psychological support: face up to dilated cardiomyopathy and heart failure, cooperate with treatment; pay attention to reducing mental stress, and seek help from professionals if necessary.
10. Proper exercise: After stable heart failure, proper aerobic exercise can be carried out under the monitoring of healthcare workers. Increasing exercise tolerance and improving quality of life are the core contents of cardiac rehabilitation treatment.
11. Improve sleep: Work and rest regularly, ensure adequate sleep, and avoid neurological disorders.
Through the above methods, patients with dilated cardiomyopathy can improve their quality of life to a certain extent and delay the progress of the disease. Importantly, patients need to actively cooperate with the doctor’s treatment plan and follow up regularly in order to adjust the treatment plan in time. At the same time, patients and their families should receive education on disease management, including how to identify the symptoms of heart failure and how to carry out daily self-management, so as to improve the self-management ability of patients.
Dilated cardiomyopathy
