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Hibernation and heart failure
  1. P G Camici
  1. Correspondence to:
    Paolo G Camici MD
    MRC Clinical Sciences Centre, Hammersmith Hospital, Ducane Road, London W12 ONN, UK;

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Heart failure accounts for approximately 20% of all hospital admissions among people over 65, and in the past 10 years the hospitalisation rate has increased by almost 160%.1 Although different large randomised trials carried out during the past two decades have demonstrated a significant reduction in mortality for heart failure patients treated medically, symptomatic heart failure continues to have a one year mortality close to 45%.23

In an effort to improve the early recognition of heart failure, the American College of Cardiology and the American Heart Association have recently proposed a new approach to the classification of heart failure based on four progressive stages.4 This new categorisation emphasises the evolution and progression of heart failure and is quite different from the traditional New York Heart Association (NYHA) classification whose primary objective was to describe functional limitations. Although this recent classification underscores the risk factors and structural abnormalities, which are necessary for the development of heart failure, patients are considered independent of the origin of their condition and no major emphasis is placed on the aetiology.


In over two thirds of cases heart failure is secondary to coronary artery disease. The increasingly successful treatment and reduced mortality of acute coronary syndromes has increased the prevalence of chronic heart failure in patients with coronary artery disease.5 Evidence from non-randomised studies suggests that in patients with post-ischaemic heart failure, coronary revascularisation can lead to symptomatic and prognostic benefits.5 To understand the reasons for the beneficial effects of revascularisation, it is necessary to review the underlying mechanisms of heart failure in patients with coronary artery disease. This is generally the result of three factors:

  • Permanent myocyte loss due to infarction with scar formation—The size of the infarct can be reduced by prompt thrombolysis with rapid “door to …

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