Heart Failure Epidemic: It's Complicated….

Abstract

Article, see p 12 > “In examining disease, we gain wisdom about anatomy and physiology and biology. In examining the person with disease, we gain wisdom about life.” > > —Oliver W. Sacks, The Man Who Mistook His Wife for a Hat Twenty years ago, the onset of a new epidemic of heart failure (HF) was heralded.1 Although an in-depth review of 2 decades of work on the HF epidemic cannot be conducted herein, several points are important to contextualize this editorial. HF is a syndrome2 classified according to the left ventricular ejection fraction (EF) into reduced or preserved EF. As a chronic condition with frequent exacerbations, HF is the most frequent cause of hospitalizations in the United States.3 To investigate this epidemic, one must accurately ascertain the incidence of HF and whether each episode is truly an incident (the first one to occur) or a recurrence. Doing so requires comprehensive longitudinal data, which are seldom available, and few studies can provide that information. Available data indicated that, until the turn of the century, the incidence of HF was mostly stable while survival was improving, leading to conclude that the HF epidemic was partly an epidemic of hospitalizations as survivors became candidates for recurrent hospitalizations.4,5 Over the past decade, evidence indicates that the incidence of HF is declining, particularly for HF with reduced EF, with no change in mortality.6 The proportion of HF with preserved EF has been increasing. This phenotype is incompletely understood, likely heterogeneous, and lacks specific treatment, which stalls progress against the epidemic. These observations underscore the importance of surveillance to understand how HF manifests itself according to person, time, and place, and precise surveillance is a prerequisite to plan and monitor interventions and design policies. Because most of the currently available surveillance …