Heart failure is a significant public health issue. Epidemiological surveys using clinical findings suggest that between 1–2% of western adult populations are affected by heart failure. More recent data, however, based on objective cardiac assessment, suggest that 2% is the more accurate figure.1 ,2

Further evidence from the US show that in the last 20 years there has been a fourfold increase in unadjusted mortality rates for heart failure (fig 1). The most obvious reason for this is the increase in the aging population, although changes in classification may be another factor. Prevalence is also increasing because more people are surviving myocardial infarcts (fig 2). There is an inexorable relation between patients surviving an acute myocardial infarction and the subsequent development of heart failure. Therefore, if the number of patients surviving acute myocardial infarction increase, it is almost certain that an increasing heart failure prevalence will follow.