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Contemporary management of heart failure in clinical practice
  1. J G F Cleland
  1. Correspondence to:
    Professor John GF Cleland, Department of Cardiology, Castle Hill Hospital, Castle Road, Cottingham, University of Hull, Kingston upon Hull, UK;
    J.G.Cleland{at}hull.ac.uk

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Heart failure is common. It affects, depending on definition, between 1–5% of the population or between 0.5 and 3 million people in the UK.1 Prospective follow up of a large cohort of non-institutionalised elderly patients (aged >70 years) over six years showed that 15% developed heart failure before they died and that 24% of all deaths over this period were preceded by heart failure.2 Heart failure is the most common reason for admission to hospital in people aged over 60 years and complicates many more admissions.3–5 Using narrowly defined criteria, about 5% of medical beds are occupied by patients with heart failure,4,6 but broader definitions of heart failure suggest it may be 2–4 times this figure. A survey of elective, non-cardiovascular, surgical admissions suggested that 14% of patients also suffered from heart failure.7

Heart failure is disabling. As reported above, heart failure is sufficiently debilitating to cause a large number of hospital admissions. It is also the most common reason for early readmission of patients.8 Studies conducted in non-hospitalised patients suggest that heart failure continues to cause gross impairment of the quality of life after discharge.9,10 A recent large European survey of heart failure in primary care suggested that half of patients remained moderately or severely symptomatic on therapy, perhaps because treatment was suboptimal for most patients.11 Heart failure is also an important risk factor for stroke and renal failure.12,13

Heart failure is deadly. The three year mortality of patients with new onset heart failure is about 60%, with evidence of a small improvement over the last 15 years.3,14,15 Mortality is biphasic, with a six month mortality of 35–40% and a 7–10% annual mortality for the entire population thereafter.3,14 If only six …

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