Epidemiology, prevalence, treatments, and clinical trials

Heart failure affects approximately 5 million patients in the United States and accounts for more than 1 million hospitalizations each year. The direct costs of heart failure are approximately $12 billion a year, most of which is spent on hospitalization. Four main issues must be taken into account in treating the patient with chronic heart failure (CHF): the of coronary artery disease (CAD) in 70% of heart failure patients, the absence of congestion in most patients (70%) until late-stage disease, the fact that as many as 40% have preserved systolic function, and the frequency of sudden unexpected death in more than 50% of patients who died. Angiotensin- converting enzyme (ACE) inhibitors represent the most important therapeutic class of agents for heart failure. These agents prevent left ventricular enlargement, improve exercise duration and symptomatology, decrease hospitalization, and improve survival. Digoxin, when added to ACE inhibitors and diuretics, prevents a worsening of heart failure and decreases hospitalization. Beta-blockers may prolong survival and reduce hospitalization. Other agents for which data in heart failure are inconclusive include hydralazine/ nitrate combinations and calcium channel blockers.