Overview of studies of exercise training in chronic heart failure: the need for a prospective randomized multicentre European trial.

Chronic heart failure is considered a 'major public health problem' and is increasing in epidemic proportions. In fact, heart failure is the only common cardiovascular condition that is increasing in incidence, prevalence, and mortality, and remains responsible for major human and economic costs[ll. A study performed among general practitioners in London reported a prevalence of heart failure in four out of every 1000 patients in the general population[21. The most consistent and striking observation is the dramatic relationship between age and the occurrence of heart failure: in the population above 65 years of age the prevalence is 28 per 1000 patients[21. Similar findings have been reported in Finland[31 and Sweden[41. Patients with chronic heart failure require frequent hospitalization, but also they may need assistance in their daily tasks because of functional disabilities. The social and economic costs of this syndrome are therefore high and are expected to increase further in the future. This is the result of the ageing of the population, because of improved survival following major cardiac events (such as myocardial infarction), and because of progress in the medical and surgical therapy of heart failure. As a consequence, chronic heart failure places an enormous burden on health care resources. A recent survey has estimated that in Italy each year 190 000 patients need care at hospital cardiology units and about 65 000 are admitted as inpatients[51. In the U.S.A., in 1993 heart failure was the primary diagnosis listed in 875000 hospital discharges a 70% increase since 1983[61. This accounts for more than 6·5 million days of care. As with other statistics related to heart failure, hospitalizations are more predominant in older patients (78% of hospitalizations are of patients 65 years or older; 53% are of