New Strategies for Improving Heart Failure Management
New Strategies for Improving Heart Failure Management
Most patients with heart failure today are treated by primary care practitioners, not cardiologists. The Consensus Recommendations for the Management of Chronic Heart Failure, developed by the Advisory Council to Improve Outcomes Nationwide in Heart Failure, provide practice guidelines for the prevention, diagnosis, and treatment of heart failure. Although hemodynamic abnormalities contribute to the symptoms of heart failure, disease progression is attributable to neurohormonal abnormalities, primarily activation of the renin-angiotensin system and the sympathetic nervous system. Pharmacologic treatment that antagonizes these neurohormonal abnormalities reduces the morbidity and mortality associated with heart failure. Guidelines recommend that patients with systolic dysfunction and symptoms of fluid retention receive a diuretic followed by an angiotensin-converting enzyme inhibitor, and, once the patient is euvolemic, a ß-blocker. Digoxin may be added to therapy for patients with persistent symptoms or rapid atrial fibrillation. Clinical trials have shown that such combination regimens reduce the risk of hospitalization and death in patients with heart failure.
Heart failure is a major public health problem in the United States. While the prevalence of most other cardiovascular diseases has declined dramatically over the past several decades, heart failure prevalence has increased markedly. Approximately 4.6 million Americans currently have heart failure, and about 400,000 new cases occur each year. The prevalence of the disease increases with age, affecting approximately 1% of persons in their fifth decade and nearly 10% of those aged 80 to 89.
Heart failure contributes directly or indirectly to approximately 260,000 deaths annually. Median survival after the onset of heart failure is 1.7 years for men and 3.2 years for women, and the 5-year mortality rate is about 50%. In 1996, heart failure was listed as the primary diagnosis in 870,000 hospital discharges. Moreover, heart failure may be an associated condition in as many as 2.5 million additional discharges annually. Heart failure is the leading cause of hospitalization in persons 65 years of age and older. One third of patients who are hospitalized for heart failure either die or require readmission within 60 days of hospital discharge, and one half are readmitted within 90 days.
In 1991, health care costs for heart failure totaled $38.1 billion, or 5.4% of estimated total health care expenditures for that year. An estimated $23.1 billion was spent on inpatient care, $14.7 billion on outpatient care, and $270 million on heart transplantations. The total figure does not include indirect costs of heart failure, such as lost productivity and decreased quality of life.
Most patients with heart failure today are treated by primary care practitioners, not cardiologists. The Consensus Recommendations for the Management of Chronic Heart Failure, developed by the Advisory Council to Improve Outcomes Nationwide in Heart Failure, provide practice guidelines for the prevention, diagnosis, and treatment of heart failure. Although hemodynamic abnormalities contribute to the symptoms of heart failure, disease progression is attributable to neurohormonal abnormalities, primarily activation of the renin-angiotensin system and the sympathetic nervous system. Pharmacologic treatment that antagonizes these neurohormonal abnormalities reduces the morbidity and mortality associated with heart failure. Guidelines recommend that patients with systolic dysfunction and symptoms of fluid retention receive a diuretic followed by an angiotensin-converting enzyme inhibitor, and, once the patient is euvolemic, a ß-blocker. Digoxin may be added to therapy for patients with persistent symptoms or rapid atrial fibrillation. Clinical trials have shown that such combination regimens reduce the risk of hospitalization and death in patients with heart failure.
Heart failure is a major public health problem in the United States. While the prevalence of most other cardiovascular diseases has declined dramatically over the past several decades, heart failure prevalence has increased markedly. Approximately 4.6 million Americans currently have heart failure, and about 400,000 new cases occur each year. The prevalence of the disease increases with age, affecting approximately 1% of persons in their fifth decade and nearly 10% of those aged 80 to 89.
Heart failure contributes directly or indirectly to approximately 260,000 deaths annually. Median survival after the onset of heart failure is 1.7 years for men and 3.2 years for women, and the 5-year mortality rate is about 50%. In 1996, heart failure was listed as the primary diagnosis in 870,000 hospital discharges. Moreover, heart failure may be an associated condition in as many as 2.5 million additional discharges annually. Heart failure is the leading cause of hospitalization in persons 65 years of age and older. One third of patients who are hospitalized for heart failure either die or require readmission within 60 days of hospital discharge, and one half are readmitted within 90 days.
In 1991, health care costs for heart failure totaled $38.1 billion, or 5.4% of estimated total health care expenditures for that year. An estimated $23.1 billion was spent on inpatient care, $14.7 billion on outpatient care, and $270 million on heart transplantations. The total figure does not include indirect costs of heart failure, such as lost productivity and decreased quality of life.
Source...