Clinical epidemiology of heart failure
- 1Department of Cardiology, Meander Medical Centre, Amersfoort, The Netherlands
- 2Julius Centre for Health Sciences and Primary Care, University Medical Centre, Utrecht, The Netherlands
- Correspondence to:
Dr Arend Mosterd
Department of Cardiology, Meander Medical Centre, PO Box 1502, 3800 BM Amersfoort, The Netherlands;
The aim of this paper is to review the clinical epidemiology of heart failure. The last paper comprehensively addressing the epidemiology of heart failure in Heart appeared in 2000.w1 Despite an increase in manuscripts describing epidemiological aspects of heart failure since the 1990s,1 additional information is still needed, as indicated by various editorials.w2 w3
The evaluation and management of heart failure is schematically depicted in fig 1. Following some methodological considerations, most issues indicated in fig 1 (risk factors, aetiology, prevalence, incidence, prognosis, prevention) will be discussed.
The therapeutic management of patients diagnosed with heart failure is beyond the scope of this paper, as is detailed information about the possible diagnostic tests and strategies to establish or rule out heart failure, although the prevailing definitions and categorisations of the syndrome will be discussed. The guidelines of the European Society of Cardiology and selected reviews provide up to date information on the diagnosis and therapeutic management of heart failure.2w4 w5
DEFINITION AND CLASSIFICATION OF HEART FAILURE
Heart failure is a syndrome with symptoms and signs caused by cardiac dysfunction, resulting in reduced longevity. To establish a diagnosis of heart failure, the European Society of Cardiology guidelines warrant the presence of symptoms and signs (tables 1 and 2), objective evidence of cardiac dysfunction (preferably by echocardiography), and, in case of remaining doubt, a favourable response to treatment directed towards heart failure.w5 To support the failing heart numerous compensatory mechanisms occur, including activation of the neurohormonal system.2 An increase in natriuretic peptide concentrations (particularly B type natriuretic peptide) is considered a hallmark of heart failure.
The diagnosis of heart failure, especially when relying solely on symptoms and signs (which is often the …