EPIDEMIOLOGY OF CARDIAC-FAILURE AND PROGN OSIS OF THE MOST SERIOUSLY ILL PATIENTS

The lack of consensus concerning the diagnostic criteria of cardiac fa ilure explains the relative paucity of epidemiological data. Most of t he available information comes from American health registers and the Framingham study: in the United States, there are more than 3 million people with cardiac failure (over 1 % of the population) and over 400 000 new patients each year. Cardiac failure is the main cause of death in 40 000 deaths and an associated cause in a further 250 000 deaths. In the Framingham study (1948-1988) the mean survival time after diag nosis is 1.7 year in men and 3.2 years in women, corresponding to 1 an d 5 year survival rates of 57 % and 25 % in men and 64 % and 38 % in w omen. These figures are worse than those of the large scale therapeuti c trials of the last 10 years and represent survival of the most sever e cases. Although not strictly epidemiological data, analysis of the l arge scale trials allows evaluation of the clinical features and survi val of patients under optimal medical treatment (ACE inhibitors associ ated with other treatments); these results are important to bear in mi nd when considering alternative therapies (transplantation, mechanical assist devices), the accessibility of which may be limited for reason s of availability or cost. In terms of public health, it is important that accurate epidemiological data concerning cardiac failure, in part icular severe cardiac failure, is made available in France.