Epidemiology of heart failure

The "epidemic" of heart failure (HF), first recognized in the 1980s and 1990s, observed a steady rise in hospitalizations for heart failure. Many factors underlay this epidemic including an aging population, better survival from myocardial infarction, increased risk associated with diabetes, hypertension, and other factors. And a greater sensitivity and ability to detect the condition was evidenced by a growing number of outpatient diagnoses at an earlier and milder stage. The incidence or new cases of heart failure have remained stable or even fallen slightly in recent years. Nonetheless with better detection and survival, prevalence or the number of cases in the population has steadily increased. This resulted in a rise in hospitalizations and more patients with increased severity. For those studying population trends, diagnosis and measurement are a challenge. The clinical syndrome of HF depends on physical signs and symptoms to make the diagnosis a matter of clinical judgment. The emergence of HF with preserved ejection fraction and reduced ejection fraction adds to the complexity with these two entities differing in natural history. The epidemic of HF appears to be blunted, but it still accounts for a substantial portion of hospitalizations and an enormous burden in mortality and costs. Advanced therapeutic technologies such as those described in other chapters will continue to prolong life and add to the costs of care.