Introduction

Heart failure is increasing in prevalence.1 This is in part due to reduced mortality as a result of major advances in treatment since 1986, when the VHEFT-I study was published.2 It is also associated with ageing of the population, and longer survival of people with conditions that lead on to heart failure such as ischaemic heart disease, hypertension and atrial fibrillation.

The incidence and prevalence of heart failure rise with age. In the 1980s the Framingham study of those aged ≥45 years found that the age-adjusted prevalence of overt heart failure was 24/1000 in men and 25/1000 in women.3 In Finland the prevalence of heart failure in those aged 75–86 years was 8.2%.4 The EPIC study found that the prevalence of heart failure in those aged >25 years in Portugal was 4.36%.5

The annual age-adjusted incidence of heart failure in the Framingham study (in the 1980s) was 7.2 cases/1000 in men and 4.7 cases/1000 in women.3 The annual incidence rises steeply with advancing age to 40 cases per 1000 for those aged >75 years.6 Furthermore, the Hillingdon study found that the incidence of heart failure rises to 1% per annum in the population over 85 years of age.7 The mortality of new cases of heart failure is 14% at 6 months.8 Hospitalised patients with heart failure have a 10% inpatient mortality rate, and up to 32% mortality rate at 1 year.9

In 2003, the National Institute for Health and Clinical Excellence (NICE) produced its clinical guideline on the diagnosis and management of chronic heart failure.10 This provided detailed guidance for healthcare professionals on the full spectrum of care for patients with heart failure. Since then, advances in the evidence base necessitated a partial update of the guideline, published in 2010, covering diagnosis, pharmacological therapy, monitoring and …