Organisation of the care of patients with heart failure

Abstract

Heart failure is a major cardiovascular problem with a steadily increasing incidence and prevalence. 1-5 These increases are due to a higher proportion of elderly individuals in the population and also because effective treatment of acute myocardial infarction and hypertension exposes more patients to the risk of heart failure than in the past. Recent epidemiological studies that included patients without symptoms of heart failure suggest that the prevalence may greatly exceed that of earlier estimates. 6 Based on data from the Framingham Study 2 the median survival is only 1.7 years in men and 3.2 years in women. Despite advances in the treatment of heart failure the prognosis remains poor. 7'~ Heart failure is associated witl~ frequent admissions to hospital which are a substantial: burden on health-care providers? Furthermore, there are shortcomings in the diagnosis of heart failure and, even when correctly diagnosed, optimum treatment is not always given in accordance with current guidelines. 1°'1~ There is a need to improve the care of patients with heart failure. The entire spectrum of heart-failure management should be taken into account, and this includes the provision of adequate resources for diagnosis, the creation of an infrastructure that can meet the needs associated with treatment based on evidence from clinical trials, and the development of innovative strategies for optimum care of heart-failure patients in different settings (ie, urban vs rural or primary care vs specialist care).