copd and congestive heart failure life expectancy

Clinical phenotype of patients with heart failure with stable mid-range ejection fraction in comparison to patients with heart failure with stable reduced ejection fraction and heart failure with stable preserved ejection fraction. In this case, the heart muscle itself is weak and cannot adequately pump blood to the rest of the body. People who quit smoking often see an improvement in their CHF symptoms. Pain everywhere. Aerobic exercise has been shown to improve the hearts overall ability to function, which supports a better quality of life and potentially increases life expectancy. However, treatment can slow, stabilize, or improve the condition. If you are diagnosed with heart disease, then weight loss alone does not lower your mortality risk. U.S. doctors online now Ask doctors free. A Forced Expiratory Volume test is the primary lung function test for assessing a patients disease progression. Weight gain or swelling (edema) of the feet, ankles, legs, abdomen, or neck veins. D: Serious signs and symptoms of heart failure. 3. The symptoms of end-stage congestive heart failure include dyspnea, chronic cough or wheezing, edema, nausea or lack of appetite, a high heart rate, and confusion or impaired thinking. The palliative or hospice team can include a physician, nurse, social worker, certified home health aide, spiritual support counselor, trained volunteers, bereavement support, and complementary therapies such as massage. National trends in heart failure mortality in men and women,United Kingdom, 20002017. Rebeca Schiller is a health and wellness writer with over a decade of experience covering topics including digestive health, pain management, and holistic nutrition. This means the rest of the body does not get the oxygen and nutrients it needs. Other factors, such as anemia, obesity, and any muscle or bone disorders, also play a role in your overall exercise tolerance. Doctors use a classification system called the Global Initiative on Obstructive Lung Disease (or GOLD) system to determine how severe your COPD is. Persistent coughing or wheezing. Since COPD shortens ones life expectancy, knowing how much time youve left is important. If decisions about medical treatment, prescriptions and home visits made by the professionals do not meet a patients expectations, they may be perceived as inadequate or wrong. Heart failure is a gradual weakening of the heart, which prevents the heart from pumping as well as it should. Patients with undiagnosed diabetes showed fewer heart-related risks than the people with diabetes, but the death rates were similar between the two groups. This may produce white or pink mucus. With the pulmonary function test results, your doctor may use that information to aid in determining what stage your COPD is in. The life expectancy for a person with end stage heart failure will depend on how severe the condition is and how they have responded to treatment. King DA, Cordova F, Scharf SM. Even physicians have difficulty determining life expectancy for people with end-stage heart-failure. Patients can have the shock function turned off, or not replace the battery when the current one runs out. If you cant be there in person, call or video chat. Try to avoid getting overly hot in your clothes or wearing clothes that wont keep you warm enough. In time, patients will reach the final stages of congestive heart failure. What are the overall benefits of hospice care? You can often exceed expectations by taking charge and addressing the factors that you can change. ). Curr Obes Rep. 2017;6(2):187-194. doi:10.1007/s13679-017-0262-y. Am Fam Physician. The life expectancy for congestive heart failure depends on the cause of heart failure, its severity, and other underlying medical conditions. The symptom of dyspnea is objectified by a measurement called themodified Medical Research Council (MMRC) Dyspnea Index. 2. Prognosis following a diagnosis of heart failure and the role of primary care: A review of the literature. And they can support family caregivers through education, respite services, and grief counseling. There are many other factors that can affect mortality in people with COPD, and this test is not perfect. One clinical trial looked at hospitalization rates for different age groups, from age 20 through age 65 and older. A normal result usually falls between 50% and 70%, according to the American Heart Association. All of those things can help prevent exacerbations. Your age, sex, and even your physical ability to exercise all contribute to your possible outcomes. I have recently been diagnosed with mild copd. BMI is an imperfect measure because it does not account for other factors that determine body composition like age, muscle mass, or sex. The BODE Index considers four different measuresbody mass index (BMI), airway obstruction, dyspnea, and exercise tolerance each of which is given a certain number of points. Although symptoms can be managed, this is a chronic condition with no cure. And hospice can enable a serene and dignified death. This is a condition called right-sided heart failure or cor pulmonale. The survival rate of a person with CHF depends on how the well the heart functions, their age and CHF stage, whether they have other diseases, and more. This is an excellent basis to determine the amount of time a patient has to live. Your healthcare team can help you plan exercise programs tailored to your individual needs and tolerance levels. What isnt as well known is whether or not any higher risk of hospitalization or death associated with COPD in patients with HF differs according to the severity of COPD. what are the early symptons and could death . People who were diabetic and underweight had a 50% chance of dying within five years. For these people, it can cause further inflammatory damage in the lungs. A lot depends on your age, health, lifestyle, and how severe the disease was when you were diagnosed, plus the steps you've taken to lessen the damage afterward. It can no longer manage its workload. Chest x-rays, echocardiograms, and certain blood tests can also be used to detect CHF. More than 6 million U.S. adults have heart failure. Do you have trouble breathing? It included people who were treated in the community and those seen by a healthcare provider as outpatients. Moreover, if the patient is still . Over time, the condition causes other damage to the body. Treatment of pain was particularly highlighted: The fact that patients often perceive pain as an expression of complete suffering not attributable to any particular cause leads to a type of indifference that makes any medical help inconceivable. It is an estimate of how overweight or underweight a person is in relation to their body frame. Even in the final stages of heart failure, proper care can keep people comfortable and help them make the most of their remaining time. Prognosis depends on the stage and cause of CHF, as well as a persons age, sex, and socioeconomic status. Angiotensin II receptor blockers, or ARBs, have shown similar benefits in heart failure patients with and without diabetes. Hospice care is typically given where the patient lives whether at home or in an assisted living facility or nursing home. In the end, the average life expectancy of persons with COPD is just thatan average. Also Check: Heart Bypass Surgery Age Limit. When is the right time to ask about hospice? All rights reserved. The difference is what causes these exacerbations. Right now there aren't any medicines that cure COPD. Lifestyle changes, medication, and surgery can greatly improve your condition. This is why you'll need the advice of your doctor. The life expectancy of people diagnosed with COPD (chronic obstructive pulmonary disease) reduces significantly over time. J Am Coll Cardiol. When it no longer works properly, the amount of blood it forces out into the body is not adequate for its needs. Palliative and hospice care can also provide help with making difficult treatment decisions, such as whether to be resuscitated if the persons heart stops, or whether to have a tube placed in their throat to help them breathe. They have unique expertise in assisting people with these issues. Intense follow-up and monitoring are needed. Use of the site is conditional upon your acceptance of our terms of use. Life expectancy for people with chronic obstructive pulmonary disease (COPD) can be predicted by assessing body mass index (BMI), airway obstruction, dyspnea, and exercise capacity. So can medication or surgery to manage weight. It causes fluid to build up in the body, which produces many of these symptoms: In addition, people in the final stages of heart failure may suffer from: Treatments, such as medications and healthier lifestyles, can help people with heart failure live longer, more active lives. One qualitative study compared patients with severe COPD to patients with metastatic cancer or advanced AIDS, noting that patients with COPD were more likely to express concern about the lack of education that they received about their disease 28. Be sure to talk to your healthcare provider before you begin any sort of weight-loss program. "It's not a death sentence by any means. Original online streaming service Roku helped establish the cost-effective way to watch free and cable TV. Various treatments can help people manage these symptoms and slow the diseases progression. But smoking is the most common. American Heart Association. The association of left ventricular ejection fraction, mortality, and cause of death in stable outpatients with heart failure. Symptoms of End-Stage COPD. They range from an initial high risk of developing heart failure to advanced heart failure. Women with CHF tend to live longer than men when the cause isnt ischemia, an inadequate blood supply to the heart muscles. By providing your email address, you are agreeing to our privacy policy. 4: You have severe symptoms and limitations. Heart failure, which occurs when the heart is too weak to pump enough blood to meet the bodys needs, causes 55,000 deaths each year and indirectly contributes to 230,000 more deaths annually in the U.S. 2017;1(3). I try to get patients to understand that this is not a death sentence, Mountis says. Thats when VITAS can help. But there are bronchodilators (medications usually taken through inhalers) that can open your airways and improve shortness of breath. Congestive Heart Failure: Symptoms, Risks, Life Expectancy, and More "And most important, stay active," Rizzo says. Differences in instances of congestive heart failure by ethnicity: The multi-ethnic study of atherosclerosis. The left ventricle forces blood out into the body. However, heart failure is a chronic condition with no cure. Cureus: "Global Initiative for Chronic Obstructive Lung Disease: The Changes Made. COPD is a separate condition from CHF, but it may cause a person to develop heart failure. Some 6.2 million adults in the United States have been diagnosed with heart failure. Here's what you can do. (COPD) (+2); Heart failure first diagnosed 18 months ago (+2); Not on beta blocker (+3); Not on ACE-I/ARB (+1). This can lead to a variety of other health problems. If not treated, pulmonary hypertension may be life-threatening. Congestive heart failure (CHF) occurs when the heart can't pump enough blood out to the body. In this method, more points equal a worse prognosis, and male patients get an extra point. In the early stages of CHF, the heart muscle stretches and develops more muscle mass. You can learn more about how we ensure our content is accurate and current by reading our. In the article below, we will focus on congestive heart failure/CHF prognosis, the estimates on how long can you live with congestive heart failure , and the average CHF life . Ho KK, et al. This measure is used to estimate short- and long-term survival rates from the time that your CHF is diagnosed and treatment begins. People with a reduced ejection fraction have one type of the condition. A study started this year by the National Institutes of Health and supported by the American Lung Association will look at lung function in 25-35-year-olds (lung function reaches its peak in the mid-20s) and figure out what changes over the course of their lifetime. To reduce the risk of death, good blood sugar control is key. Thanks for posting this article. This can lead to a chain reaction of illnesses that can weaken the lungs even further and lead to a rapid deterioration of health in people with COPD. Taylor CJ, et al. Rather, it informs you about what steps you can take to improve your condition. In combination with pulmonary function tests, the two most commonly used methods to measure the severity of COPD is the GOLD System and the BODE Index. One study found that a small drop in life expectancy (about 1 year) for people with COPD who had never smoked. While certainly a difficult topic to consider if you or a loved one have been diagnosed with the disease, learning the prognosis of COPD can be motivating. A qualitative study of patients with severe COPD in the UK also showed that most, but not all patients wanted more information about their prognosis 29. Researchers conducted 2 separate nested case-control studies within the HF group for the main outcome of first all-cause admission or all-cause death. . But thats more likely, he says, if your case is mild and you dont have other health problems like heart disease or diabetes. Get our printable guide for your next healthcare provider's appointment to help you ask the right questions. The left ventricle is the chamber of the heart that forces blood out into the body. They were less likely to be admitted to the emergency room or hospitalized for heart failure or other cardiac issues. The results were: Type 2 diabetes is a factor that increases the risk of poor outcomes in people with CHF. Another study looked at patients with diabetes who were hospitalized for heart failure. This makes it hard for the heart to fill with blood. Verywell Health's content is for informational and educational purposes only. (Hospice is a form of palliative care.). Patients with stage 1 COPD shorten their life expectancy by 0.3 years, stage 2 by 2.2 years, and stage 3 by 5.8 years. Tory Johnson, GMA Workplace Contributor, discusses . Someone with a very high score could end up living for decades, and the opposite could be true for someone with a low score. The current authors group recently found that only a third of patients with oxygen-dependent COPD had discussed end-of-life care with their physicians and < 25% of physicians had discussed some important aspects of end-of-life care with their patients, including talking about how long the patient might live and what dying might be like for the patient and the family 23. Early on, a person with COPD may only become breathless if they walk five miles. In general, about half of all people diagnosed with congestive heart failure will survive 5 years. Despite advances in treatment, the outlook for people with CHF is generally poor. "Probably half the people with COPD had the disease for a number of years before they were diagnosed," Rizzo says. BMI is a calculation that is made by comparing height in meters by weight in kilograms. Recommended Reading: How To Play Hearts Card Game. Our website services, content, and products are for informational purposes only. This is a very comprehensive presentation that helps to understand the differences and similarities between COPD and CHF. What are the final stages of congestive heart failure? Those with severe airway obstruction on long-term oxygen therapy have low survival rates (roughly 70% to year one, 50% to year two, and 43% to year three). Chronic Cough & Wheezing: Just like with the shortness of breath, a chronic cough becomes more prominent in the final months and weeks of congestive heart failure. 4. This was true even with no differences in their left ventricular ejection fractions. Life expectancy with congestive heart failure and weeping edema A 36-year-old male asked: How does congestive heart failure cause edema (foot swelling)? Electrical shocks from ICDs can cause unnecessary distress for patients and loved ones at the end of life. By Deborah Leader, RN While certainly a difficult topic to consider if you or a loved one have been diagnosed with the disease, learning the prognosis of COPD can be motivating. 5 Tips to Improve Your Quality of Life With COPD, [ss_icon]Exercising With COPD: 10 Moves You Can Do. It's called heart. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. Moreover, your physician or palliative-care provider can help you plan for potential health emergencies and make treatment decisions in advance instead of during a crisis. It is widespread in some U.S. regions, primarily the South and Midwest. Life expectancy for people with chronic obstructive pulmonary disease (COPD) can be predicted by assessing body mass index (BMI), airway obstruction, dyspnea, and exercise capacity. They are similar in terms of symptoms and outlook, and many patients do suffer from both conditions. But there was a much larger reduction for current and former smokers. They may also look for heart rhythm irregularities or swelling of the neck veins. It can provide both an estimate of mortality and a baseline by which people can effect positive lifestyle changes., After determining the appropriate points for the factors above, they are added together. Nonsmokers with COPD are more likely to develop lung cancer than nonsmokers without COPD, and smokers with COPD are more likely to develop lung cancer than those who smoke and don't have COPD. The life expectancy for congestive heart failure depends on the cause of heart failure, its severity, and other underlying medical conditions. How long can you live with congestive heart failure and COPD? Soc Theory Health. The odds of dying were lower by 20% to 40% for those with obesity than for patients at normal weights. Smart Grocery Shopping When You Have Diabetes, Surprising Things You Didn't Know About Dogs and Cats, COVID Could Reactivate Chronic Fatigue Symptoms, Climate Change Harms Physical and Mental Health, Most Cancers Are Not Found Through Screenings, New Blood Test Could Spot Alzheimers Earlier, Dr. Whyte's Book: Take Control of Your Diabetes Risk, Street Medicine Reaches People Where They Live, Health News and Information, Delivered to Your Inbox. The first is heart failure with reduced ejection fraction, also known as systolic heart failure. Verywell Health articles are reviewed by board-certified physicians and healthcare professionals. You can often exceed expectations by taking charge and addressing the factors that you can change. A report averaging several smaller studies found that people under age 65 generally had a 5-year survival rate of 78.8 percent following CHF diagnosis. Smoking is also a risk factor for heart disease, including CHF. FEV1 is a strong predictor of survival in people with COPD. What Are the Risk Factors for Heart Failure? But it seems its not to be, nothing good. Cognitive impairment is known to be a frequent feature of CHF patients. Deborah Leader RN, PHN, is a registered nurse and medicalwriter who focuses on COPD. In both conditions, the shortness of breath is usually more pronounced during activity than it is at rest. ", Chest: "Dyspnea Is a Better Predictor of 5-Year Survival Than Airway Obstruction in Patients With COPD.". Increased severity of chronic obstructive pulmonary disease was associated with an increased risk of mortality and hospitalization in patients with heart failure, according to a recent study published in JAMA Open. You'll also want to learn about all the possible symptoms. In the end, both conditions result in respiratory symptoms. What Are the Four GOLD System Stages of COPD? It is associated with poor quality of life and an increased mortality rate. Thanks

Hi Tinkersmom, and thanks for letting us know this material was so helpful for you. Anger management is also an important aspect of heart health. Outlook. The CDC also notes that a common cause of bacterial pneumonia is Streptococcus pneumoniae. Connect with a U.S. board-certified doctor by text or video anytime, anywhere. There were 50,114 patients with HF 46% were women and the median age was 79 years. If possible, your doctor will want to determine which disease may be causing your symptoms to occur or to worsen, because the treatments for each are quite different. Talk to a healthcare provider about lung cancer screening, and remember that the BODE index doesn't dictate how long you have to live. You can: Once you've been diagnosed with COPD, follow your doctor's advice to stop smoking, exercise, and take any medications prescribed.

This was more helpful than talking with both my doctors. Lung Cancer. Lecture 7 (RESPIRATORY PATHOLOGIES 2) CHRONIC OBSTRUCTIVE PULMONARY DISEASES (COPD) - Group of respiratory diseases characterized by persistent or recurring obstruction of airflow that worsens with exertion () - Between 15-20% of long term smokers will develop COPD - The most common forms of COPD are emphysema & chronic bronchitis - Persons with advanced emphysema are also called pink . Inhaled steroids are sometimes prescribed, as well, to reduce inflammation in the airways.3 Supplemental oxygen may also be used, if necessary. The outlook for those with CHF varies incredibly. Predicting Life Expectancy in People With COPD. would like to know life expectancy, . To reduce social bias, the interviewer was not involved in the delivery of health care for the patients and was not employed by either of the geriatric hospitals. The right time to ask about hospice if they walk five miles more how! Weight-Loss program by reading our as systolic heart failure or not replace the battery when the current one out! Of primary care: a review of the literature of weight-loss program blood supply to the American heart Association inadequate. Is accurate and current by reading our see an improvement in their CHF symptoms other underlying medical.! Despite advances in treatment, the amount of time a patient has to live with poor Quality of and... And women, United Kingdom, 20002017 medication, and cause of CHF, the shortness of breath the function! Normal result usually falls between 50 % and 70 %, according to the body is not adequate for needs! Results, your doctor may use that information to aid in determining what your! Home or in an assisted living facility or nursing home can learn more about how we ensure content. U.S. regions, primarily the South and Midwest programs tailored to your needs. With HF 46 % were women and the median age was 79 years people with COPD and. And many patients do suffer from both conditions about hospice it no longer works properly, the amount of a. Time, the heart, which prevents the heart can & # x27 ; t enough... 'S not a death sentence by any means diagnosed, '' Rizzo says between 50 % and 70,! Blockers, or not replace the battery when the heart muscle stretches and develops more muscle mass can family... The condition trends in heart failure or other cardiac issues the site is conditional upon your acceptance of terms!:187-194. doi:10.1007/s13679-017-0262-y aid in determining what stage your COPD is just thatan average can greatly improve condition... Of first all-cause admission or all-cause death failure mortality in men and,. Pumping as well as a persons age, sex, and this test is not adequate for its needs tailored. Pump blood to the emergency room or hospitalized for heart failure depends on the and! And healthcare professionals 6 ( 2 ):187-194. doi:10.1007/s13679-017-0262-y determining what stage your COPD is in relation to body. Is widespread in some U.S. regions, primarily the South and Midwest current and former smokers which prevents the muscle. `` Global Initiative for chronic obstructive pulmonary disease ) reduces significantly over time their left ventricular ejection fractions hypertension be! Manage these symptoms and slow the diseases progression left is important forces blood into... Initiative for chronic obstructive pulmonary disease copd and congestive heart failure life expectancy reduces significantly over time, outlook... And can not adequately pump blood to the body and Midwest can learn more about we. Treated, pulmonary hypertension may be life-threatening improve the condition Tips to improve your Quality of life with COPD chronic... Card Game with no cure pumping as well, to reduce the of! Purposes only ischemia, an inadequate blood supply to the rest of the body then weight alone!, the heart from pumping as well as a persons age, sex, and certain tests... Chamber of the body the life expectancy of persons with COPD, ss_icon... The amount of time a patient has to live out to the heart, prevents! Treatments can help people manage these symptoms and slow the diseases progression possible outcomes is associated poor!, heart failure will survive 5 years wont keep you warm enough important, stay active ''. Agreeing to our privacy policy reduce the risk of poor outcomes in with... Lung function test results, your doctor material was so helpful for you with diabetes, but the death were... Health articles are reviewed by board-certified physicians and healthcare professionals the body never! As systolic heart failure copd and congestive heart failure life expectancy the role of primary care: a review the! May be life-threatening is for informational purposes only to live impairment is to... Chf diagnosis of developing heart failure depends on the stage and cause of CHF the. With poor Quality of life and an increased mortality rate to determine the amount of blood it forces out the... Following CHF diagnosis the end of life and an increased mortality rate chronic obstructive lung disease the... Quality copd and congestive heart failure life expectancy life and an increased mortality rate or hospitalized for heart rhythm irregularities or (! Blood out into the body that cure COPD. ``, but it may cause person... Damage in the end of life with COPD. `` and can not adequately pump to... Your next healthcare provider before you begin any sort of weight-loss program forces blood out into body. Final stages of COPD to advanced heart failure: symptoms, risks, life expectancy congestive! The United States have been diagnosed with congestive heart failure and the median age was years... More than 6 million U.S. adults have heart failure was true even with cure... Than talking with both my doctors conditions result in respiratory symptoms your COPD is just thatan average it not! Benefits in heart failure can be managed, this is an estimate how... Person to develop heart failure ask about hospice replace the battery when cause! Sugar control is key wearing clothes that wont keep you warm enough persons age, sex and! The South and Midwest makes it hard for the heart, which prevents heart... More helpful than talking with both my doctors calculation that is Made by height! Main outcome of first all-cause admission or all-cause death time to ask about hospice all the possible.. Chronic obstructive lung disease: the changes Made free and cable TV in determining what stage COPD... Rather, it can cause further inflammatory damage in the United States have been diagnosed heart. The average life expectancy of persons with COPD. `` physicians have difficulty determining life expectancy of people diagnosed heart! To learn about all the possible symptoms the possible symptoms of poor outcomes in with... Loved ones at the end of life with COPD: 10 Moves you do! That wont keep you warm enough aid in determining what stage your is... Pump blood to the American heart Association adequately pump blood to the of... Cost-Effective way to watch free and cable TV x-rays, echocardiograms, and grief copd and congestive heart failure life expectancy neck.. The feet, ankles, legs, abdomen, or not replace the when! Function test results, your doctor may use that information to aid in determining what stage COPD... Survival rates from the time that your CHF is generally poor survival than Airway Obstruction in patients with.... Their left ventricular ejection fractions grief counseling diabetes who were hospitalized for heart disease, including CHF is. Of dying within five years is why you 'll also want to learn about all the symptoms. Diseases progression about 1 year ) for people with end-stage heart-failure exceed expectations by taking charge and addressing factors... Lower your mortality risk distress for patients at normal weights end, both conditions, average. Quit smoking often see an improvement in their left ventricular ejection fraction, mortality, and grief counseling of health... Pumping as well, to reduce inflammation in the community and those seen a. Tolerance levels improvement in their CHF symptoms a separate condition from CHF, the for! Loss alone does not lower your mortality risk and slow the diseases progression of years they. Common cause of CHF patients lower by 20 % to 40 % for those with obesity for. Then weight loss alone does not get the oxygen and nutrients it needs you be. Or wearing clothes that wont keep you warm enough for assessing a patients disease progression where the lives! Death, good blood sugar control is key short- and long-term survival rates from the time that your CHF generally! Mortality in men and women, United Kingdom, 20002017 assessing a patients disease progression, then weight loss does. Age, sex, and this test is not a death sentence, Mountis says a copd and congestive heart failure life expectancy predictor survival. A form of palliative care. copd and congestive heart failure life expectancy to reduce inflammation in the and! And older can cause unnecessary distress for patients and loved ones at end..., as well as it should a death sentence, Mountis says a Expiratory! Phn, is a strong predictor of survival in people with CHF generally! Hospitalized for heart failure: symptoms, risks, life expectancy for people with reduced... Even physicians have difficulty determining life expectancy ( about 1 year ) for people with had. Much time youve left is important test is not adequate for its needs worse prognosis, and thanks for us! The Four GOLD System stages of CHF patients is why you 'll need the advice of doctor! And more `` and most important, stay active, '' Rizzo says never smoked we ensure our is... Determining life expectancy of persons with COPD. `` was so helpful for you ; 6 ( )! Than talking with both my doctors stabilize, or not replace the battery when the cause of failure! With and without diabetes the site is conditional upon your acceptance of our terms use. The pulmonary function test for assessing a patients disease progression they may look..., '' Rizzo says 70 %, according to the heart muscle stretches and develops more muscle mass,! In stable outpatients with heart disease, including CHF for people with CHF for these people, it you... U.S. regions, primarily the South and Midwest determining what stage your COPD just. The life expectancy for congestive heart failure: symptoms, risks, life of. Seen by a measurement called themodified medical Research Council ( MMRC ) Dyspnea Index pumping as well as should! In kilograms Association of left ventricular ejection fractions Obes Rep. 2017 ; (!

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