ABC of heart failure: History and epidemiology

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A brief history Descriptions of heart failure exist from ancient Egypt, Greece, and India, and the Romans were known to use the foxglove as medicine. Little understanding of the nature of the condition can have existed until William Harvey described the circulation in 1628. Röntgen's discovery of x rays and Einthoven's development of electrocardiography in the 1890s led to improvements in the investigation of heart failure. The advent of echocardiography, cardiac catheterisation, and nuclear medicine have since improved the diagnosis and investigation of patients with heart failure. The foxglove was used as a medicine in heart disease as long ago as Roman times Blood letting and leeches were used for centuries, and William Withering published his account of the benefits of digitalis in 1785. In the 19th and early 20th centuries, heart failure associated with fluid retention was treated with Southey's tubes, which were inserted into oedematous peripheries, allowing some drainage of fluid. View larger version: In this window In a new window Southey's tubes were at one time used for removing fluid from oedematous peripheries in patients with heart failure A brief history of heart failure View this table: In this window In a new window It was not until the 20th century that diuretics were developed. The early, mercurial agents, however, were associated with substantial toxicity, unlike the thiazide diuretics, which were introduced in the 1950s. Vasodilators were not widely used until the development of angiotensin converting enzyme inhibitors in the 1970s. The landmark CONSENSUS-I study (first cooperative north Scandinavian enalapril survival study), published in 1987, showed the unequivocal survival benefits of enalapril in patients with severe heart failure. In 1785 William Withering of Birmingham published an account of medicinal use of digitalis View larger version: In this window In a new window Mortality curves from the CONSENSUS-I study Key references Clarke KW, Gray D, Hampton JR . Evidence of inadequate investigation and treatment of patients with heart failure. Br Heart J 1994;71:584–7. Cowie MR, Mosterd A, Wood DA, Deckers JW, Poole-Wilson PA, Sutton GC, et al . The epidemiology of heart failure. Eur Heart J 1997;18:208–25. Cowie MR, Wood DA, Coats AJS, Thompson SG, Poole-Wilson PA, Suresh V, et al . Incidence and aetiology of heart failure: a population-based study. Eur Heart J 1999;20:421–8. Dries DL, Exner DV, Gersh BJ, Cooper HA, Carson PE, Domanski MJ . Racial differences in the outcome of left ventricular dysfunction. N Engl J Med 1999;340:609–16. Ho KK, Pinsky JL, Kannel WB, Levy D . The epidemiology of heart failure: the Framingham study. J Am Coll Cardiol 1993;22:6–13A. Lip GYH, Zarifis J, Beevers DG . Acute admissions with heart failure to a district general hospital serving a multiracial population. Int J Clin Pract 1997;51:223–7. McDonagh TA, Morrison CE, Lawrence A, Ford I, Tunstall-Pedoe H, McMurray JJV, et al . Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population. Lancet 1997;350:829–33. The Task Force on Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis of heart failure. Eur Heart J 1995;16:741–51.

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