Fortnightly Review: Diagnosis and management of heart failure

#### Summary points Doctors diagnose heart failure when patients whom they suspect of having heart disease develop fatigue, dyspnoea, or oedema. By these standards, this is a terminal condition because in severe cases its annual mortality may exceed 60 %1 Even in so called mild cases detected in community screening programmes such as the Framingham study the five year mortality approached 50 %.2 These survival rates are worse than for many of the common forms of cancer, emphasising that heart failure is indeed a malignant condition. Heart failure also imposes a heavy burden of symptoms. In studies of the major chronic illnesses such as diabetes, arthritis, and hypertension, heart failure had the greatest negative impact on quality of life, and not just slightly so.3,4 The high morbidity is also reflected in the number of hospital admissions for heart failure, about 120 000 cases each year in the United Kingdom.5,6 These represent 5% of all adult medical and geriatric admissions and are about the same as the number of admissions for acute myocardial infarction.7 Heart failure is a serious public health problem, with a prevalence in the United Kingdom, Scandinavia, and the …

[1]  F. Tristani,et al.  Effect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure. Results of a Veterans Administration Cooperative Study , 1987 .

[2]  K. Swedberg,et al.  Effects of the early administration of enalapril on mortality in patients with acute myocardial infarction. Results of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II) , 1992, The New England journal of medicine.

[3]  F. Tristani,et al.  Effect of Vasodilator Therapy on Mortality in Chronic Congestive Heart Failure , 1986 .

[4]  David Hunt,et al.  ISIS-3 - A RANDOMIZED COMPARISON OF STREPTOKINASE VS TISSUE PLASMINOGEN-ACTIVATOR VS ANISTREPLASE AND OF ASPIRIN PLUS HEPARIN VS ASPIRIN ALONE AMONG 41,299 CASES OF SUSPECTED ACUTE MYOCARDIAL-INFARCTION , 1992 .

[5]  E. Varnauskas,et al.  Effect of chronic beta-adrenergic receptor blockade in congestive cardiomyopathy. , 1975, British heart journal.

[6]  G. Schuler,et al.  Regular Physical Exercise and Low‐Fat Diet: Effects on Progression of Coronary Artery Disease , 1992, Circulation.

[7]  B. W. East,et al.  Effects of enalapril in heart failure: a double blind study of effects on exercise performance, renal function, hormones, and metabolic state. , 1985, British heart journal.

[8]  [Effectiveness of digitalis in patients with chronic heart failure and sinus rhythm. Review of randomized, double-blind and placebo controlled studies]. , 1993, Herz.

[9]  D. DeMets,et al.  Effect of oral milrinone on mortality in severe chronic heart failure. The PROMISE Study Research Group. , 1991, The New England journal of medicine.

[10]  R. Klein,et al.  The Beaver Dam Health Outcomes study , 1993, Medical decision making : an international journal of the Society for Medical Decision Making.

[11]  F. Harrell,et al.  Surgical survival benefits for coronary disease patients with left ventricular dysfunction. , 1988, Circulation.

[12]  R. Bain,et al.  Effects of vesnarinone on morbidity and mortality in patients with heart failure , 1993 .

[13]  E. J. Brown,et al.  Effect of captopril on mortality and morbidity in patients with left ventricular dysfunction after myocardial infarction. Results of the survival and ventricular enlargement trial. The SAVE Investigators. , 1992, The New England journal of medicine.

[14]  S. Rahimtoola,et al.  The hibernating myocardium. , 1989, American heart journal.

[15]  K. Swedberg,et al.  Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). , 1988, The American journal of cardiology.

[16]  S. Yusuf,et al.  Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions. , 1992, The New England journal of medicine.

[17]  P. F. F. G. R. Heyndrickx M.D..  Hibernating myocardium , 2004, Basic Research in Cardiology.

[18]  ISIS-1 Collaborative Group.  ISIS-3: a randomised comparison of streptokinase vs tissue plasminogen activator vs anistreplase and of aspirin plus heparin vs aspirin alone among 41 299 cases of suspected acute myocardial infarction , 1992, The Lancet.

[19]  B. W. East,et al.  Relation of arrhythmias and electrolyte abnormalities to survival in patients with severe chronic heart failure. , 1987, Circulation.

[20]  G. Riegger.  Effects of quinapril on exercise tolerance in patients with mild to moderate heart failure. , 1991, European heart journal.

[21]  W. Kannel,et al.  The natural history of congestive heart failure: the Framingham study. , 1971, The New England journal of medicine.

[22]  W. Elliott,et al.  Dopamine and dopamine receptor agonists in cardiovascular therapy , 1990, Critical care medicine.

[23]  K. Nademanee.  The amiodarone odyssey. , 1992, Journal of the American College of Cardiology.

[24]  D. Barnett.  HEART FAILURE Diagnosis of symptomless left ventricular dysfunction , 1993, The Lancet.

[25]  Craig D. Miller,et al.  Management of Patients With Intramural Hematoma of the Thoracic Aorta , 1993, Circulation.

[26]  M. Gheorghiade,et al.  WITHDRAWAL OF DIGOXIN FROM PATIENTS WITH CHRONIC HEART FAILURE TREATED WITH ANGIOTENSIN CONVERTING ENZYME INHIBITORS , 2010 .

[27]  J. Nolan,et al.  Non-rheumatic atrial fibrillation: warfarin or aspirin for all? , 1992, British heart journal.

[28]  G. Tognoni,et al.  The GISSI Study: further analysis. Italian Group for the Study of Streptokinase in Myocardial Infarction (Gruppo Italiano per lo Studio della Streptochinasi nell'Infarto Miocardico, GISSI). , 1987, Circulation.

[29]  F. Tristani,et al.  A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic congestive heart failure. , 1991, The New England journal of medicine.

[30]  L. Tan,et al.  Diagnosis of symptomless left ventricular dysfunction , 1993, The Lancet.

[31]  Y. Ohtsuki,et al.  ISOLATION OF HTLV-I FROM CEREBROSPINAL FLUID OF A PATIENT WITH MYELOPATHY , 1986, The Lancet.

[32]  Withdrawal of digoxin from patients with chronic heart failure treated with angiotensin-converting-enzyme inhibitors. , 1993 .

[33]  S. Saksena,et al.  Survival of implantable cardioverter-defibrillator recipients: role of left ventricular function and its relationship to device use. , 1992, American heart journal.

[34]  H. Teufelsbauer,et al.  Clinical and neurohumoral response of patients with severe congestive heart failure treated with two different captopril dosages. , 1993, European heart journal.

[35]  B. W. East,et al.  Captopril in heart failure. A double blind controlled trial. , 1984, British heart journal.

[36]  Sarah Parish,et al.  Randomized trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2.ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. , 1988, Journal of the American College of Cardiology.

[37]  M. Wilén,et al.  Comparative effects of therapy with captopril and digoxin in patients with mild to moderate heart failure. The Captopril-Digoxin Multicenter Research Group. , 1988, JAMA.

[38]  F. Kleber,et al.  Impact of converting enzyme inhibition on progression of chronic heart failure: results of the Munich Mild Heart Failure Trial. , 1992, British heart journal.

[39]  Failure to treat heart failure , 1992, The Lancet.

[40]  J. Cohn.  Effect of vasodilator therapy on mortality in chronic congestive heart failure. , 1988, European heart journal.

[41]  Gruppo Italiano per lo Studio della Soprawivenza nell'Inf Miocardico..  MEDICAL SCIENCE GISSI-2: A factorial randomised trial of alteplase versus streptokinase and heparin versus no heparin among 12 490 patients with acute myocardial infarction , 1990, The Lancet.

[42]  H. Dargie,et al.  Coronary heart disease. , 1991, BMJ.

[43]  A. Stewart,et al.  Functional status and well-being of patients with chronic conditions. Results from the Medical Outcomes Study. , 1989, JAMA.

[44]  H. Herrmann,et al.  Multicenter trial of oral enoximone in patients with moderate to moderately severe congestive heart failure. Lack of benefit compared with placebo. Enoximone Multicenter Trial Group. , 1990, Circulation.

[45]  J. McMurray,et al.  ACE inhibitors for myocardial infarction and unstable angina , 1992, The Lancet.

[46]  S. Mujais,et al.  Principles and clinical uses of diuretic therapy. , 1992, Progress in cardiovascular diseases.

[47]  Gissi -Gruppo Italiano per lo Studio della Sopravvivenza Miocardico.  GISSI-3 study protocol on the effects of lisinopril, of nitrates, and of their association in patients with acute myocardial infarction. , 1992, The American journal of cardiology.

[48]  Salim Yusuf,et al.  Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure. , 1991, The New England journal of medicine.

[49]  R. Rossaint,et al.  Inhaled nitric oxide: its effects on pulmonary circulation and airway smooth muscle cells. , 1993, European heart journal.

[50]  G. Sutton.  Epidemiologic aspects of heart failure. , 1990, American heart journal.

[51]  J. Cleland,et al.  Effect of captopril, an angiotensin-converting enzyme inhibitor, in patients with angina pectoris and heart failure. , 1991, Journal of the American College of Cardiology.

[52]  R. Byington,et al.  Effect of propranolol after acute myocardial infarction in patients with congestive heart failure. , 1986, Circulation.

[53]  T. Ryan,et al.  Acute and long-term effects of enalapril on the cardiovascular response to exercise and exercise tolerance in patients with congestive heart failure. , 1985, Journal of the American College of Cardiology.