Heart failure is a growing epidemic in the world. In the USA, it is estimated that the annual incidence of heart failure is 550 000 patients and the number of hospital discharges for heart failure was almost a million in 2001. The cost of treating heart failure in 2004 is estimated to be $28.8 billion dollars. Eighty per cent of men under the age of 65 years with heart failure will die within eight years.¹ Facing these stark statistics, it is recognised that a heart failure disease management programme is necessary to curb the rising cost of managing heart failure and to improve the morbidity and mortality associated with heart failure.

Heart failure disease management (HFDM) recognises that heart failure is a chronic debilitating disease for which the optimal treatment would require a holistic approach adapted to each patient’s unique set of medical, psychosocial, behavioural, and financial circumstances. The HFDM includes the following components: heart failure practice guidelines, a multidisciplinary team approach, a target patient population, and a system by which to assess the measures of outcomes of the disease management program.

HEART FAILURE PRACTICE GUIDELINES

Since 1995, the American Heart Association and the American College of Cardiology have set out guidelines for the pharmacological treatment of heart failure. The latest revision was published in 2001.² Similarly, the European Society of Cardiology and other national cardiac societies have also promulgated guidelines for the management of heart failure. Numerous large multicentre trials have established the evidence base for the usefulness of angiotensin converting enzyme (ACE) inhibitors, second and third generation β blockers, angiotensin receptor blockers, digoxin, aldosterone antagonists, and the isosorbide–hydralazine combination in reducing morbidity and mortality in heart failure patients.

MULTIDISCIPLINARY TEAM APPROACH

A multidisciplinary team approach is needed in managing heart failure patients …