Optimal Medical Therapy for Heart Failure

Abstract

Heart failure (HF) remains a major cardiovascular health problem, afflicting millions of people worldwide. Nearly 5 million patients in the United States have HF, and nearly 500000 patients are initially diagnosed with HF every year. Framingham databases estimate that a person has 1 in 5 chances of developing HF in their lifetime. The incidence of HF more than doubles with each decade after the age of 45 years, and approximately 35% of all new HF diagnosis result in hospitalization in the subsequent 12 months. The disorder is the underlying reason for 12 to 15 million office visits and 6.5 million hospital days each year. During the last 10 years, the annual number of hospitalizations has increased from approximately 550000 to nearly 900000 for HF as a primary diagnosis and from 1.7 to 2.6 million for HF as a primary or secondary diagnosis. Heart failure is primarily a disease of the elderly. Approximately 6% to 10% of people older than 65 years have HF, and approximately 80% of patients hospitalized with HF are older than 65 years. Heart failure is the most common Medicare diagnosis-related group, and more Medicare dollars are spent for the diagnosis and treatment of HF than for any other diagnosis. Heart failure is a syndrome that can be caused by a variety of conditions that result in damage to the myocardium. Coronary artery disease is the single most common cause of HF, with a significant increase in the number of patients who can be identified, from 29% to 40%, when coronary angiography is systematically used in addition to clinical criteria. In a minority of patients, isolated hypertension is regarded as the primary cause of HF; however, it frequently coexists with coronary artery disease. However,