Specialized centers for heart failure management.

Abstract

The incidence of many forms of cardiovascular disease, such as acute myocardial infarction and stroke, has been on the decline over the past two decades. During this same time, the incidence of heart failure has markedly increased.1 2 In 1970, there were 250 000 new cases of heart failure diagnosed in the United States.1 By 1988, this number had grown to 400 000 cases,1 and in 1992, nearly 700 000 new cases of heart failure were identified.2 This increasing incidence of heart failure in the United States has resulted in a current prevalence of heart failure of nearly 5 million cases, or ≈1.5% of the US population.2 Moreover, heart failure is a disease syndrome associated with aging; that is, both the incidence and prevalence of heart failure increase in the elderly population. For example, if one examines the prevalence of heart failure in those more than 75 years old, nearly 10% of this elderly population exhibits the clinical syndrome of chronic heart failure.3 Given this, heart failure is now the most common diagnosis-related group (DRG) discharge diagnosis for those aged more than 65 years old, and it is the fourth leading cause of hospitalization in US adults.4 This has resulted in a substantial economic burden. Estimates of the total direct costs of heart failure treatment in the United States range from $10 billion to nearly $40 billion.2 5 6 Data recently summarized by Konstam et al5 for the Agency for Health Care Policy and Research indicate the following annual expenditure for heart failure in 1990 through 1991: hospital days, $7.5 billion; nursing home days, $1.9 billion; drugs, $0.2 billion; and physician visits, $0.7 billion. In 1991, the Health Care Financing Administration (HCFA) spent $5.45 billion for the inpatient management of heart …