The scale of heart failure: diagnosis and management issues for primary care

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Abstract
Heart failure is a significant public health issue. Epidemiological surveys using clinical findings suggest that between 1–2% of western adult populations are affected by heart failure. More recent data, however, based on objective cardiac assessment, suggest that 2% is the more accurate figure.1 2 Further evidence from the US show that in the last 20 years there has been a fourfold increase in unadjusted mortality rates for heart failure (fig 1). The most obvious reason for this is the increase in the aging population, although changes in classification may be another factor. Prevalence is also increasing because more people are surviving myocardial infarcts (fig 2). There is an inexorable relation between patients surviving an acute myocardial infarction and the subsequent development of heart failure. Therefore, if the number of patients surviving acute myocardial infarction increase, it is almost certain that an increasing heart failure prevalence will follow. Figure 1 Increasing prevalence of heart failure. Figure 2 Risk of heart failure following myocardial infarction. There are three issues to consider in terms of the impact of heart failure. Mortality is related to disease severity, so prognosis is determined by stage of heart failure. Looking at heart failure overall, the five year mortality rate of 50% is analogous to that of many cancers. The prognosis for moderate and severe heart failure is almost identical to colorectal cancer3 and worse than breast4 or prostatic cancer,5 which develop at a similar age to heart failure (table 1). Interestingly, the impact of breast cancer is considered sufficiently significant to warrant a national screening programme for women from the age of 50 years. In the US there are also formal screening programmes for prostatic cancer. View this table: Table 1 Survival rates compared with heart failure3–5 The second issue relates to high health care costs, largely related to the use …