• Cardiac resynchronisation therapy
• heart failure
• NYHA class I/II
• implantable defibrillator
• reverse remodelling

Prevention of heart failure progression has become a major challenge for our healthcare system. About one out of five 40-year-old adults will develop heart failure at some point in their lifetime, the likelihood increasing with growing age.1 Due to better treatment options for coronary artery disease, valve disease or arrhythmias, the likelihood of developing some form of heart failure later in life is very high. This ‘paradox’ of decline in mortality and morbidity of one form of cardiac disease, accompanied at the same time by an increase of another form of heart disease, will impose an enormous burden on overall healthcare costs.

Age adjusted heart failure hospitalisations have tripled within the last 25 years, according to US National Hospital Discharge Survey Data. In particular, the diagnosis of heart failure increased for patients hospitalised with a condition other than cardiac disease, who had heart failure listed as a second diagnosis.2 Since heart failure is a constantly progressing disease, recurrent hospitalisations with heart failure symptoms are common. Despite better treatment options, recently published data showed that about 25% of all patients who were discharged alive after hospitalisation for heart failure needed hospital readmission within the next 30 days.3 These facts indicate that an enormous effort will be necessary to improve heart failure treatment, particularly in preventing heart failure progression.4 5

Although medical treatment improves prognosis and reduces symptoms of heart failure, drugs are unable to reverse electrical or mechanical dyssynchrony. Cardiac resynchronisation therapy (CRT) combined with medical therapy has been demonstrated to improve cardiac function and quality of life, and to reduce heart failure hospitalisations as well as overall mortality in patients with moderate or severe heart failure symptoms6–10 (figure 1). Therefore, CRT with or without defibrillator back-up has been implemented into current guidelines for heart failure treatment.11 …