Heart failure: Current concepts

Abstract

The clinical syndrome of heart failure is the final pathway for myriad diseases that affect the heart. Incidence of heart failure today is approaching 10 per 1000 population among persons older than 65 years of age. Heart failure is the reason for at least 20% of all hospital admissions among persons older than 65 years. Symptomatic heart failure has a one-year mortality of approximately 45%. Although there has been a substantial reduction in mortality of patients with systolic heart failure, overall death rates in large epidemiologic surveys have remained the same [1]. Why have the newer and successful therapies failed to result in a meaningful reduction in mortality due to heart failure? It is important to recognize that heart failure is a clinical syndrome arising from diverse causes. Not all patients with the condition have poorly contracting ventricles and a low ejection fraction. Many have uncorrected valvular disease, such as aortic stenosis or mitral regurgitation, or abnormal filling, resulting in diastolic heart failure. A large majority of patients with heart failure are elderly, and 75% of patients have a history of hypertension. Many patients have at least one serious coexisting condition, in addition to advanced age. Heart failure is largely preventable, primarily through the control of blood pressure and other vascular risk factors. The new approach to the classification of heart failure [2] emphasizes its evolution and progression and defines four stages: Stage A Patients with risk factors for the development of heart failure. Stage B Patients with structural abnormality of the heart. Stage C Patients with structural abnormality of the heart and current or previous symptoms of heart failure. Stage D Symptoms of endstage heart failure that are refractory to standard treatment.