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Abstract
Heart failure is estimated to affect 4 to 5 million Americans, with 550 000 new cases reported annually.1 In the past 3 decades, both the incidence and prevalence of heart failure have increased.1 2 3 Factors that have contributed to this increase are the aging US population and improved survival rates in patients with cardiovascular disease due to advancements in diagnostic techniques and medical and surgical therapies.2 4 5 6 Heart failure is a chronic, progressive disease that is characterized by frequent hospital admissions and ultimately high mortality rates. Because of its high medical resource consumption, heart failure is the most costly cardiovascular illness in the United States.7 Advances in the treatment of heart failure and early intervention to prevent decompensation may delay disease progression and improve survival. After initial evaluation, further diagnostic testing, and implementation of standard medical therapy, outpatient management strategies focus on maintenance of patient stability. Patient counseling/education, promotion of compliance, and discharge planning may further contribute to clinical stability and improved patient outcomes. A variety of outpatient heart failure management programs have been implemented during the past decade. These programs may also contribute to improved heart failure patient outcomes, including decreased symptoms, improved quality of life, reduced rates of hospital admission, and decreased healthcare costs. The purpose of the present report was to examine current heart failure management strategies and programs and to provide recommendations regarding (1) the use of an integrated approach to care through systematic assessment and management, (2) counseling and education of patients, (3) promotion of patient compliance with the treatment regimen, and (4) facilitation of hospital discharge/implementation of outpatient models of healthcare delivery. ### Pathophysiology and Definition of Heart Failure The syndrome of heart failure is a result of complex interactions among molecular, endocrine, and biodynamic systems. There are several pathophysiological mechanisms that are involved …
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