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Heart failure is a descriptive clinical syndrome, which encompasses the consequences of both right and left ventricular dysfunction (systolic and non-systolic). Systolic left ventricular dysfunction, about which there is most epidemiological and experimental evidence, is a malignant disease. In a recent population based study more than one third of patients had died within 12 months of diagnosis.1
Estimates of the prevalence of systolic left ventricular dysfunction range from 3–20 per 1000 in the general population. Over the age of 65 this value rises to 30–130 per 1000.2
The true prevalence of the syndrome of heart failure is probably significantly higher, because of asymptomatic systolic left ventricular dysfunction and of “diastolic” (or non-systolic) left ventricular dysfunction. Taking a crude prevalence of systolic left ventricular dysfunction of 2% suggests that one million people are affected in the UK. Two thirds will die within five years. Despite this, to date heart failure has received less attention than its cancerous counterparts (table 1).3 This contrast is highlighted by the recent recommendation of a two week maximum on the time patients with suspected cancer should wait for review.
The number of heart failure cases is likely to rise. This is because of the successful management of ischaemic heart disease, which serves to defer a cohort of cardiac morbidity, the better management of patients who already have heart failure, and the increasing numbers of elderly patients in the population. Elderly patients with heart failure are often taking several medications and have little understanding of their condition.4 They are frequently readmitted, often because of poor symptom control and reduced compliance.5
TREATMENT OF HEART FAILURE
Several highly effective treatments exist for heart failure and authoritative guidelines have been produced.6,7 Despite the …