HEART-FAILURE - IMPLICATIONS OF THE TRUE SIZE OF THE PROBLEM

We review current knowledge on the true size of the clinical condition known as 'heart failure' in terms of epidemiological information and in relation to the true clinical burden, Population studies, together with data from physician and general practitioner records, reveal a ra nge of estimated heart-failure prevalence of 1-10%, Estimated incidenc e rates vary from approximately 0-1% per annum, Reasons for variation include age, sex and, possibly, methodology. In community studies, the five-year mortality is between 50-60% while, in patients requiring ho spital admission, the annual mortality is 10-20% in those with mild-mo derate symptoms, and as high as 40-60% in severe heart failure. While angiotensin-converting enzyme (ACE) inhibitor treatment does significa ntly improve mortality in all grades of symptomatic heart failure, the annual mortality in severe patients was still 36% in CONSENSUS I. It is obvious that the term 'heart failure' is insufficiently descriptive or specific to be an acceptable label for all patients who might bene fit from treatment. As 'clinical' heart failure is often an advanced a nd irreversible state, studies of its antecedents are important in dev eloping strategies aimed at retarding the progression from the asympto matic to the symptomatic conditions, The true prevalence of the most c ommon antecedent, left ventricular dysfunction, has received relativel y little attention.