The Key to Unraveling the Mystery of Mortality in Heart Failure

Abstract

Heart failure (HF) is a growing public health problem in the United States. Nearly 5 million Americans suffer from HF, and an estimated 550 000 new cases of HF are diagnosed each year.1 HF is the No. 1 discharge diagnosis in patients ≥65 years of age and results in a substantial burden on healthcare expenditures. It is estimated that in 2001, more than $24 billion was spent as direct cost for the care of patients with HF.1 Furthermore, HF is associated with a significant increase in morbidity and mortality. See p 1764 Although considerable progress has been made in our approach to the pharmacological management of patients with HF, most patients remain at increased risk of cardiac death. To further improve outcomes in patients with HF, newer therapeutic modalities, including devices such as biventricular pacemaker, automatic internal cardioverter-defibrillators (AICDs), and left ventricular assist devices, have been increasingly utilized. Several recent randomized controlled trials have shown that such devices can indeed further improve the outcome in patients with HF.2–4 However, these devices are expensive, and their widespread or injudicious application in unselected patients with HF is likely to have a substantial impact on healthcare expenditures. On the other hand, appropriate use of device therapy in properly selected patients (who are at high risk of mortality) is essential to improve clinical outcome. Thus, there is a need to develop a strategy to accurately identify those patients with HF who are at increased risk of mortality. The paper by Vrtovec and associates5 in the present issue of Circulation provides such a strategy by showing that routinely available diagnostic tests, such as measurement of QT interval on 12-lead ECG and measurement of B-type natriuretic peptide (BNP), can indeed identify the HF patients who are at increased risk of overall mortality, …