Managing heart failure patients: when good-old-fashioned clinical care is not enough

Chronic heart failure (CHF) is the terminus of most other chronic cardiac diseases. For many patients, CHF is a dead-end road. In advanced stages of the disease, emphasis switches from curative approaches to palliation. Hence, quality of life prevails over quantity, and the major target of management programmes is to provide adequate ambulatory care to avoid repetitive hospital admissions. In this issue of the journal, Hoppe et al1 introduce a new miniature fully implantable device, which allows wireless monitoring of pulmonary artery pressure curves (see page 1091). The main purpose of such technical innovations is to facilitate the routine evaluation of patients’ haemodynamic status and to transmit diagnostic information to health professionals. Barriers that prevent easy and rapid access to management programmes might be overcome by introducing remote care. Healthcare systems, whether governmental or privately run, are increasingly promoting telemedicine and telecare. Besides a firm belief in better management and care of patients, cost-effectiveness rules this evolution. It is the task of the medical community to guide the other players in this field, both by providing expert advise in the design of novel techniques and by testing their clinical efficacy.

A TALE OF NUMBERS, FIGURES AND STATISTICS

Chronic heart failure is on the rise, and this poses challenges to patient management and healthcare budgets. At least 15 million patients with symptomatic CHF live within a population of approximately 900 million in 51 European countries.2 For the US, the prediction is that the current number of cases with CHF will double within three decades. Two trends are the cause of this evolution. First, there is the paradoxical drawback of therapeutic success. Cardiologists have managed to cut down acute mortality following a coronary event. As a result, a growing pool of patients are initially adequately treated with antiremodelling pharmaceutics and devices, but eventually develop heart …