When I finished medical school in the 1980s, it was often easy to determine prognosis:
- Metastatic cancer of most types: Less than a year
- Cardiac ejection fraction of 15%: Less than a year
- Critical aortic stenosis in someone older than 80 (making them poor operative candidates): Less than a year
Now, everything is so different.
Daily, I see patients in their tenth year of metastatic cancer who are still active and enjoying life. Their cancer is still present and they get treated intermittently. They have some difficult months, but they also have many good months.
Cardiomyopathy with an EF of 15% used to be a death sentence. Now, with drugs, pacemakers and ICD’s, we can actually “cure” this condition.
Patients in their 90s with critical aortic stenosis now get a TAVR and most do pretty well and feel many years younger.
These treatments are extending life and doing it with decent quality. People ask: “This looks serious. How long do I have?”
My response: “I have no idea!”