90 year old has serious heart problems. What is his prognosis?

My uncle, 90 years, old has serious health problems. In March of 2007 he was told he needed a quadruple bypass and mitro valve replacement but that they wouldn鈥檛 operate because of his advanced age. So he has been on medication since then and he appears to be doing well. About two weeks ago he had difficulty with his hands and feet and actually fell a couple of times. He fell one night and it took him two hours to get into bed. He didn鈥檛 want to go to the hospital but my dad got him to go. My uncle seemed disoriented so my dad called an ambulance even though he didn鈥檛 want to go. While there he stated that they diagnosed him with pneumonia. When I talked to the nurse she mentioned Congestive Heart Failure. I have heard they can seem very similar.
He spent 3 days at the hospital and then was transferred to a continuing care facility for 3 more days. I don鈥檛 understand why and how effective the therapy was at the continuing care facility. How much can be accomplished with 3

Back in March of 2007 his EF was 20. Can this be improved?
Also, the doctors referred to his continuing care facility as a "step down" facility.

I think this would depend on the severity of his heart failure findings after they evaluated his response to therapy while in the hospital. The goal in a patient on medical therapy for a heart condition such as your Uncle's would be to diurese him (get rid of any excess fluid that may have "backed up into his lungs" making it more difficult for him to breathe). Add in a component of pneumonia and he'd be placed on antibiotics as well. Before moving him on to another facility, they would make sure he is on appropriate medications for his condition.

Someone with mild congestive heart failure that responds well with IV diuretics and is doing better, then changed to diuretic therapy in oral form, can be in and out of the hospital pretty quickly. If he had pneumonia as well, I imagine he responded well to antibiotics also. What type of continuing care facility do you mean? A rehab type place, a step down unit? Usually orders are sent to the next facility/area and should be continued as they were at the prior hospital and then adjusted by the assuming physician. It's hard to tell exactly what is/was going on with your Uncle based on the info you've provided.

Hope this is somewhat helpful.


An EF of 20% is severely diminished (normal is 55-60%), most likely caused by his significant heart disease. Unfortunately, without surgery, there isn't much chance for it to improve. Having a bad mitral valve contributes to his problem, since it also compromises the heart as an effective pump. His doctors should have him on standard heart failure medications which can at least try to optimize his quality of life. He should be on: a beta blocker, an ACE inhibitor or ARB, and a full strength aspirin daily. He would also benefit from daily diuretics such as Lasix, Bumex or Aldactone. Some patients cannot tolerate some of the medicines above as they lower blood pressure, and a few can be harsh on the kidneys. His prognosis is probably not the best given his advanced age and then add in any other co-morbitities, it can make it tough to manage. There are some really good sites on the net that can give you more info on medical management of heart failure, but like always, each situation can be so different from another. It's best to make a list of your questions and sit down with his doctors to ask them. Hope this helps.

He's 90! Get real. Make him comfortable and that's it.