Chronic Heart Failure: We Are Fighting the Battle, but Are We Winning the War?

Atherton, John J.

doi:https://doi.org/10.6064/2012/279731

Scientifica

On this page

Abstract Introduction Conclusion Abbreviations References Copyright Related Articles

Review Article | Open Access

Volume 2012 | Article ID 279731 | https://doi.org/10.6064/2012/279731

Chronic Heart Failure: We Are Fighting the Battle, but Are We Winning the War?

John J. Atherton^1,2

Academic Editor: K. Egstrup, J. Alpert

Received10 Oct 2012

Accepted31 Oct 2012

Published20 Dec 2012

Abstract

Heart failure represents an end-stage phenotype of a number of cardiovascular diseases and is generally associated with a poor prognosis. A number of organized battles fought over the last two to three decades have resulted in considerable advances in treatment including the use of drugs that interfere with neurohormonal activation and device-based therapies such as implantable cardioverter defibrillators and cardiac resynchronization therapy. Despite this, the prevalence of heart failure continues to rise related to both the aging population and better survival in patients with cardiovascular disease. Registries have identified treatment gaps and variation in the application of evidenced-based practice, including the use of echocardiography and prescribing of disease-modifying drugs. Quality initiatives often coupled with multidisciplinary, heart failure disease management promote self-care and minimize variation in the application of evidenced-based practice leading to better long-term clinical outcomes. However, to address the rising prevalence of heart failure and win the war, we must also turn our attention to disease prevention. A combined approach is required that includes public health measures applied at a population level and screening strategies to identify individuals at high risk of developing heart failure in the future.

1. Introduction

Heart failure is a clinical syndrome that represents the end-stage phenotype of a number of different cardiovascular diseases. However, regardless of the underlying cause, the prognosis is generally poor once a patient develops symptoms or signs of heart failure. There has been considerable progress in management including the use of drugs that interfere with neurohormonal activation, device therapy in selected patients, and multidisciplinary disease management. This at least partly explains the reductions in heart failure mortality seen in population-based studies over the last two decades; however, the overall epidemiological impact has been modest. This paper will provide an overview of the epidemiology of heart failure and outline our continued efforts to fight the battle focusing on management strategies that have been shown to modify disease progression. I will then consider whether or not we are winning the war and suggest that efforts to minimize variation in care should continue coupled with increasing emphasis on heart failure prevention.

2. Epidemiology of Heart Failure

Heart failure is one of the few cardiovascular diseases whose prevalence continues to rise, largely related to the aging population accompanied by improved survival in patients with heart failure and following myocardial infarction [1, 2]. Incident heart failure hospitalization rates reached a peak in the 1990s which then plateaued and in most studies now appear to be falling [3–12]. However, incident rates based upon community cohorts have shown little change [13–15], with a young adult having a 20–30% lifetime chance of developing heart failure [16, 17]. Consequently, age-adjusted prevalence rates continue to rise with heart failure imposing a substantial human and economic burden in both developed and emerging economies. In developed economies, direct costs related to heart failure account for 1-2% of the total healthcare expenditure, largely accounted for by costs incurred during hospitalization [18–20].

The prognosis of patients with heart failure is generally poor with frequent admissions to hospital throughout the disease trajectory and median survivals of 3–5 years [12–14, 17, 23–28]. There have been consistent reductions in both short-term and long-term mortality over the last two decades, which probably reflects increasing utilization of evidence-based therapies and better management of cardiovascular risk factors [3–7, 10–15, 25, 28–34]. Most of the improvement in outcomes has been in younger patients with left ventricular (LV) systolic dysfunction (LVSD), which is perhaps not surprising given that the evidence-base for disease modifying therapies is strongest in this population [4, 6, 13, 28, 35]. A recent individual patient data meta-analysis demonstrated better survival in patients with preserved LV ejection fraction (LVEF) compared with patients with reduced LVEF following adjustment for age and comorbidity [36]. These findings are consistent with a meta-analysis of prospective observational studies where LV function had been assessed in almost all patients; the long-term mortality in patients with heart failure associated with preserved LVEF was approximately one half that of patients with reduced LVEF [37]. Nonetheless, once an individual develops symptomatic heart failure, their outcome is generally poor regardless of underlying LV function [35, 38–43]. Furthermore, heart failure patients often suffer associated comorbidities, which complicate management and are associated with increased hospitalization rates and poorer survival [6, 12, 44, 45]. Indeed, this largely explains why most rehospitalizations are due to noncardiovascular diseases [45].

3. Modifying the Disease Trajectory: Evidenced-Based Management

Despite heart failure representing an end-stage phenotype of different cardiovascular diseases, numerous large-scale, randomized, and placebo-controlled studies have extended our mechanistic understanding of this syndrome. Most of these studies have been conducted in patients with moderate to severe LVSD regardless of the underlying cause. Broadly speaking, the therapeutic approaches can be divided into pharmacological therapies, device-based therapies, and coordinated disease management [46–51].

3.1. Pharmacological Therapies

Treatments primarily focused on managing congestion and hemodynamic derangements play an important role in treating decompensated heart failure with loop diuretics remaining the most effective pharmacological approach to manage congestion. However, these approaches have a limited effect on long-term clinical outcomes. Over the last three decades, a number of multicenter studies conducted in patients with symptomatic and asymptomatic LVSD have highlighted the role of neurohormonal activation on disease progression (see Table 1) [21, 52–65].

Angiotensin converting enzyme (ACE) inhibitors improve symptoms, reduce hospitalization, and prolong survival in patients with symptomatic heart failure associated with moderate to severe LVSD both early following myocardial infarction and in the setting of chronic heart failure regardless of the underlying etiology [52, 53, 55, 58, 65]. Subsequent studies have demonstrated similar benefits from angiotensin receptor blockers in the setting of heart failure associated with LVSD, either as an alternative to ACE inhibitors [54, 66], in patients who were previously intolerant of ACE inhibitors [67], or in addition to ACE inhibitor therapy [68]. Furthermore, the combined endpoint of death and heart failure hospitalization was reduced by the addition of an ACE inhibitor to standard care in patients with asymptomatic LVSD [22], which translated to improved long-term survival [21].

However, despite the well-established benefit from blockade of the renin-angiotensin system, the long-term cumulative mortality rates remained high reflecting ongoing disease progression, often associated with progressive adverse LV remodeling. Subsequent large, placebo-controlled studies emphasized the need for a combined approach to neurohormonal blockade. The addition of a beta blocker reduced mortality by 34-35% and decreased heart failure hospitalization in chronic heart failure patients with underlying moderate to severe LVSD on top of standard therapy which included an ACE inhibitor and diuretic in the majority of patients [59–61].

Given the established mechanistic role of aldosterone in the pathogenesis of cardiovascular disease and that aldosterone synthesis is only modestly suppressed by chronic renin-angiotensin system blockade [69, 70], studies have explored the therapeutic role of mineralocorticoid receptor antagonists. Consistent mortality reductions have been demonstrated on top of ACE inhibitor therapy (with or without additional beta blockade) in the setting of LVSD in both chronic heart failure and early following myocardial infarction [62–64]. Concerns have been raised regarding the broader application of dual blockade of the renin-angiotensin-aldosterone system [54], especially in the real-world setting without careful attention to patient selection and electrolyte monitoring [71]. In the Aliskiren Trial in Type 2 Diabetes Using Cardio-Renal Endpoints (ALTITUDE) study, the combination of the direct renin inhibitor, aliskiren, and either an ACE inhibitor or an angiotensin receptor blocker was associated with an increased risk of renal impairment, hyperkalemia, and hypotension. This led the US Food and Drug Administration to recommend a new contraindication against the use of this combination in diabetics and a warning to avoid the combination in patients with moderate to severe renal impairment (see http://www.fda.gov/drugs/drugsafety/ucm300889.htm). Furthermore, a population-based study conducted in Canada reported increased hospitalizations and deaths related to hyperkalemia, associated with increased rates of prescribing spironolactone to heart failure patients treated with ACE inhibitors following the publication of the Randomized Aldactone Evaluation Study (RALES) [71]. However, a more recent study conducted in Scotland suggests that regular monitoring of serum potassium and renal function allowed early identification of mild hyperkalemia and appropriate dose adjustment. Increased prescribing of spironolactone occurred in parallel with increased measurements of serum creatinine and potassium after the publication of the RALES results and did not translate to increased hospitalizations for hyperkalemia. Indeed, there was a trend of reduced rates of severe hyperkalemia over time [72].

Additional studies have reported beneficial effects of adding various 2nd-line agents in selected patients including ivabradine (in patients in sinus rhythm of 70 beats per minute or greater despite optimal medical therapy), polyunsaturated fatty acids, hydralazine and nitrates, digoxin, and intravenous iron therapy [49, 50, 73–77].

3.2. Device-Based Therapies

Combined neurohormonal blockade has been shown to reduce both heart failure related and sudden (presumed arrhythmic) deaths and, in some cases, reversal of the adverse LV remodeling process. However, progressive adverse remodeling continues despite optimal pharmacological therapy in a large proportion of patients. Implantable cardioverter defibrillator therapy reduces the risk of arrhythmic death, which translates to improved survival in patients with severe LVSD associated with symptomatic chronic heart failure or following previous myocardial infarction (see Table 1) [78, 79]. However, unlike pharmacological treatments where costs are distributed over time, the upfront costs associated with device therapies impact on cost effectiveness, which is sensitive to the projected time horizon [80–83]. Therefore, in patients where the short-to-medium-term outcomes are driven by age and associated comorbidities, these treatments are unlikely to be clinically effective and cost effective. Nonetheless, provided patients are carefully selected, the use of implantable cardioverter defibrillators for the primary prevention of sudden cardiac death in heart failure patients with severe LVSD despite optimal medical therapy appears to be cost effective [84].

Approximately 20–30% of patients with heart failure due to LVSD have abnormal intraventricular conduction manifested by a prolonged QRS duration on the 12-lead electrocardiogram [85]. Short-term studies have demonstrated that resynchronizing ventricular contraction with biventricular pacing improves symptoms, exercise capacity, and quality of life [86–88], with these benefits maintained for at least 12 months [89, 90]. Subsequent large, and randomized, controlled trials demonstrated improved long-term survival and reduced heart failure hospitalizations with cardiac resynchronization therapy (CRT) in patients with symptomatic heart failure due to severe LVSD associated with ventricular dyssynchrony (largely based upon having a prolonged QRS duration on the 12-lead electrocardiogram) despite optimal medical therapy (see Table 1) [91–95]. These benefits were seen using either isolated biventricular pacing (CRT only device) [95] or when combined with an implantable cardioverter defibrillator (CRT-D device) [92, 94]. Furthermore, recent studies have clearly demonstrated that biventricular pacing reduces morbidity and mortality on top of the reduction in sudden death associated with using an implantable cardioverter defibrillator [92, 93].

3.3. Coordinated Disease Management

The management of chronic heart failure includes lifestyle adjustment, initiation and uptitration of medical therapy, and selective consideration of device therapy. These cases are often diagnosed following an acute episode of decompensation with 25–40% of patients admitted to hospital with acute decompensated heart failure having no prior documented history of heart failure [96–98]. The patients are generally acutely unwell and during their relatively brief hospital stay are informed that they have a serious illness that requires substantial adjustments to their usual lifestyle; commenced on a number of new drugs with an average of 10-11 drugs being prescribed on discharge; that they need to undertake lifelong disease monitoring; and see their primary care practitioner for further prescriptions and electrolyte monitoring. It is therefore hardly surprising that following discharge from hospital, up to one in four patients are readmitted within 30 days [26, 27] and 30–40% of patients will die or be readmitted within 60–90 days [99]. Furthermore, most of these hospital readmissions are potentially avoidable [100].

A large body of evidence supports the use of coordinated, multidisciplinary models of care usually led by heart failure nurses to support the transition of care from the acute hospital setting to community health providers. These services have been shown to prolong survival, reduce hospitalizations, and improve quality of life [101–105]. Furthermore, they are cost effective provided that appropriate patients are selected [105, 106]. Key features of effective heart failure programs include involving a multidisciplinary team with a cardiac nurse supported by a cardiologist; in-hospital referral with discharge planning; developing an individualized healthcare plan that incorporates patient and family education and counseling; promoting self-care behaviors including daily weighing and adherence to specific lifestyle measures and medications; medication optimization; ongoing follow-up and disease monitoring; and providing a mechanism to allow patient-initiated access to advice [107, 108].

4. Process Measures of Healthcare: Are We Applying the Evidence?

Whilst there is a rich body of evidence supporting the safety and clinical efficacy of pharmacological and device-based therapies in heart failure, the key question is whether this translates to clinical effectiveness in a real-world population. Recent registries and population-based cohorts of patients admitted to hospital with acute decompensated heart failure have highlighted treatment gaps and considerable variation in the quality of care provided in different hospitals [97, 98, 109–115]. Similar variation has been reported in the ambulatory care setting [116–120]. Despite all heart failure guidelines advocating the critical role of echocardiography to confirm the diagnosis, identify the underlying mechanism of heart failure, and guide therapy, 10–25% of patients admitted to hospital with a primary diagnosis of heart failure have no documented record that LV function has been assessed [97, 98, 115, 121, 122]. This is concerning given that failure to perform an echocardiogram in heart failure patients is associated with poorer long-term survival and under-prescribing of evidenced-based therapies [123].

Whilst the rates of prescribing disease modifying agents in patients admitted to hospital with heart failure have improved over the last decade, recent registries conducted in Europe, the Asia-Pacific region, and the USA still report discharge prescription rates of 63–80% for ACE inhibitors or angiotensin receptor blockers, 41–74% for beta blockers, and 20–48% for aldosterone antagonists [97, 98, 115, 122]. Furthermore, these drugs are generally prescribed at doses much lower than those achieved in the clinical trials (see Table 2) [124–137]. Importantly, improved adherence to guidelines is associated with better long-term clinical outcomes highlighting the need to minimize variation in process measures of healthcare to improve overall clinical outcomes [119, 138].

5. Why Are Not We Applying the Evidence?

Reasons for the gaps in treatment provided in real-world practice compared to clinical trials may include the limitation of using administrative datasets to code heart failure patients, the different populations being treated, the limitation of assessing treatment in hospital following an acute decompensation, and the level of care provided.

Administrative datasets rely on appropriate documentation by the treating clinicians and accurate coding by administrative staff. A number of studies have evaluated the accuracy of administrative coding demonstrating high positive predictive accuracy compared with independent chart abstraction or objective scoring systems such as the Boston score criteria [141–143]. Whilst this may not apply in all jurisdictions and does not exclude the possibility that heart failure patients are being incorrectly coded with an alternative diagnosis, it nonetheless indicates that inaccurate coding is unlikely to explain the variation in care observed between real-world registries and clinical trials.

Patients treated in clinical trials are on average over a decade younger than the patients we see in our clinical practice. Furthermore, the clinical trials which guide our practice either exclusively or largely enrolled patients with moderate to severe LVSD; yet up to half the patients enrolled in heart failure registries and population-based cohorts have preserved LVEF [35, 97, 98, 115, 122, 144–147]. The enrollment criteria for most clinical trials generally exclude patients with major comorbidities, documented contra-indications, poor compliance, and prior drug intolerance; yet these patients dominate our clinical practice. Many clinical trials also included a prerandomization, run-in phase to identify patients who are unlikely to tolerate uptitration of medical therapy. Indeed, over 90% of patients enrolled in heart failure registries would not have met the enrollment criteria for the clinical trials which guide our practice [148]; yet we attempt to apply this evidence to all patients. However, this is unlikely to fully explain the wide variation in care both within and between different countries. Indeed, even when ideal clinical indicators are crafted to match the inclusion and exclusion criteria used in the clinical trials, substantial treatment gaps remain [98, 110–113, 148].

Hospital-based registries generally report in-hospital metrics to measure quality performance. Whilst performance of echocardiography and discharge prescription of ACE inhibitors or angiotensin receptor blockers are well-accepted inpatient quality measures of healthcare, discharge prescription of beta blockers was not included in the Joint Commission on Accreditation of Healthcare Organizations (JCAHO) heart failure performance indicators (see http://www.jointcommission.org/specifications_manual_for_national_hospital_inpatient_quality_measures.aspx). However, few patients will have new therapies commenced in the first few months following hospital discharge [113]. Indeed, most patients can be safely commenced on beta blockers prior to discharge from hospital and are then more likely to receive these drugs compared with patients where the decision to start beta blockers is deferred to their first outpatient visit. Furthermore, provided patients are appropriately selected, this practice has no adverse effect on either hospital length of stay or subsequent treatment withdrawal rates [149].

Finally, it is likely that the model of care provided in real-world practice differs substantially from that provided in clinical trials. In the real world, clinical practice will be constrained by variable clinician awareness of the guidelines, a number of external barriers, and clinical inertia. Conversely, in clinical trials, investigators are generally familiar with the trial protocol and background evidence and patients care is supported by research nurses who assist in clinical assessments at outpatient visits, regularly document pharmacotherapy, monitor compliance, provide a point-of-contact for trial participants, and apply protocol-driven, forced drug uptitration. Indeed, in many ways coordinated, multidisciplinary heart failure disease management brings us closer to the models of care provided in the clinical trials on which we base our practice.

6. Where to Now?

Over the last two to three decades, considerable therapeutic gains have been made in the management of heart failure associated with LVSD with in excess of 50% cumulative reductions in mortality and associated reductions in hospitalizations in the randomized, controlled trials (see Table 1) [46–48]. However, the epidemiological impacts have been relatively modest given that these approaches have been variably applied to a proportion of heart failure patients at a relatively late stage in their disease trajectory. Therefore, whilst we should continue to implement best practice guided by the clinical trials, we also need to focus on early disease detection and preventive strategies.

6.1. Heart Failure Management

Substantial gains will be realized simply by implementing the treatments we know to be effective. A variety of strategies can be used to close the treatment gaps including reminder systems, timely feedback, and alternative models of care [150, 151]. In The Registry to Improve the Use of Evidence-Based Heart Failure Therapies in the Outpatient Setting (IMPROVE HF) which included 34,810 patients with reduced LVEF, a number of quality initiatives including clinical decision support tools, reminder systems, chart audits with timely feedback, benchmarked reports, and educational outreach were implemented across 167 outpatient practices in the USA. This resulted in significant improvement in five of seven quality indicators including increases in appropriate beta blocker prescribing (86% to 92%), mineralocorticoid receptor antagonist prescribing (35% to 60%), CRT (37% to 66%), and implantable cardioverter defibrillators (50% to 78%) [152]. Furthermore, these quality measures were associated with improved long-term survival [138]. Similar quality improvement initiatives have been successfully trialed in the acute hospital setting [121, 153]. In the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients With Heart Failure (OPTIMIZE-HF), real-time feedback of benchmarked reports resulted in increased complete discharge instructions (47% to 67%), smoking cessation counseling (48% to 76%), assessment of LV function (89% to 92%), and beta blocker prescribing (76% to 86%). Furthermore, use of clinical decision support tools was associated with improved process measures of healthcare and lower adjusted in-hospital mortality [121].

In many centers, multidisciplinary heart failure disease management programs which incorporate a number of these quality improvement measures have been implemented. In our state of Queensland, which has a population of 4.5 million and land mass of 1.7 million square kilometers, we received government funding to appoint heart failure nurses in all 22 health districts. We developed a multidisciplinary steering committee to oversee the implementation and monitoring of these services and continue to hold an annual 2-day specialized heart failure course to support the training of nursing and allied health staff [154]. Following the implementation of the heart failure service in our hospital, we observed a reduction in occupied bed days for heart failure, which was sustained over the next three years (see Figure 1). Whilst we cannot necessarily imply cause-and-effect, it nonetheless suggests that the beneficial effects observed in clinical trials translated to clinical effectiveness in our practice.

Over 90% of newly referred heart failure patients with LVSD now receive ACE inhibitors and beta blockers in our service, however only one quarter of patients who are not on target doses of therapy when they leave hospital will achieve target doses by 6 months (unpublished data). Our local experience matches that seen in most studies that report prescribing patterns in clinical practice (see Table 2) [124–137, 155], but falls well below that seen in the clinical trials where 66–80% of patients achieved target doses of beta blockers. Heart failure services that involve nurses in protocol-driven uptitration of medical therapy are more likely to achieve target doses [133, 135, 156, 157]; however, these services are not universally available and follow-up arrangements may vary according to clinician preference and patient choice. We implemented a statewide heart failure medication uptitration form that clearly indicates who is responsible for uptitrating therapy and provides monitoring and trouble-shooting guidelines. We observed that patients who received a written uptitration plan were more than two-fold likely to achieve target doses by 6 months [158]. We are currently evaluating whether providing incentive payments to heart failure services for completing heart failure uptitration forms will further improve prescribing patterns.

The role of supplementary monitoring strategies to guide therapy and support disease management including telemonitoring and biomarkers remains the active area of investigation. Noninvasive telemonitoring has shown promise [159, 160]; however, recent large studies have been less favorable, highlighting the difficulties involved in incorporating diagnostic monitoring strategies into a continually evolving standardized model of care [161, 162] and the limited sensitivity of symptoms and weight change to identify heart failure exacerbations [163–165]. Meta-analyses of randomized, controlled trials have demonstrated that using B-type natriuretic peptides to monitor heart failure was associated with reduced mortality [166, 167], with this benefit at least partly achieved by using higher doses of disease-modifying drugs [166]. There was however no effect on hospitalization and the results of individual studies have been conflicting with none adequately powered for mortality. Furthermore, most of the studies to date have measured natriuretic peptides on an “occasional basis” (often 1-2 monthly). Given that the natriuretic peptides have a relatively short half-life measured in hours, it is likely that more frequent monitoring is required to guide therapy, especially in recently decompensated patients. Invasive monitoring using implantable devices to either directly or indirectly assess volume status allows for continuous monitoring and has been shown to identify patients at increased risk of heart failure hospitalization [168–172]. However, the low specificity of intrathoracic impedance to predict heart failure hospitalization [173] resulted in increased utilization of healthcare resources and higher rates of hospitalization in a recent randomized, controlled trial [174]. Conversely, a recent study using a wireless hemodynamic monitor demonstrated a large reduction in hospitalization in heart failure patients randomized to having daily measurement of pulmonary arterial pressure to guide their management [175]. Whilst further studies are ongoing, the clinical utility of monitoring strategies is entirely dependent on how the information provided will change management. Clinical algorithms will need to be validated and should ideally empower the patients and their family in the long-term management of their chronic disease.

Finally, most of the therapeutic gains made with drugs and device therapy have been in heart failure due to LVSD. Studies conducted in patients with preserved LVEF have been disappointing, which probably at least partly relates to the difficulty in clearly defining this population [176–178]. Further studies are awaited including the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial which is evaluating the role of mineralocorticoid receptor antagonists [179]. Comorbidities such as anemia, lung disease, kidney disease, diabetes, and depression represent major drivers of mortality, hospitalization and quality of life in heart failure patients [44, 45]. Future studies will need to improve our understanding of whether directly treating comorbidities not only improves clinical outcomes, but also modifies heart failure progression [45].

6.2. Heart Failure Prevention

Whilst efforts to improve the quality of care and clinical outcomes of heart failure patients should continue, this will have a limited epidemiological impact on the human and economic burden imposed by heart failure in our society. Unless we also focus on early disease detection and prevention, we are in effect chipping away at the tip of the iceberg as incident cases of heart failure continue to emerge. The American College of Cardiology Foundation/American Heart Association (ACCF/AHA) staging classification emphasizes the need for disease prevention akin to the approach applied in cancer prevention [139]. This classification describes presymptomatic phases where subjects are at increased risk of developing heart failure in the future which includes hypertension, atherosclerotic disease and diabetes (referred to as Stage A), and asymptomatic structural heart disease such as LVSD, LV hypertrophy, and valvular heart disease (referred to as Stage B), followed by the development of symptomatic heart failure (Stage C) and refractory heart failure despite optimized therapy (Stage D). Indeed, in a community-based, cross-sectional sample of adults aged 45 years and older, for every subject with symptomatic heart failure, there were three to four subjects with ACCF/AHA Stage A or B presymptomatic heart failure [180].

To address the presymptomatic phase of heart failure, a combined approach is required that encompasses both public health measures applied at a population level and identification and management of individuals at high risk of developing heart failure in the future. Public health measures should focus on environmental contributors with the ultimate aim being to encourage and facilitate healthy lifestyles through education, legislation, and urban planning [181]. Smoking cessation, blood pressure lowering, and LDL-cholesterol lowering reduce cardiovascular events and long-term mortality [182–184], with greater benefits in high risk individuals [185]. Furthermore, pharmacological approaches are likely to be more cost-effective if we can target them to individuals with preclinical structural cardiovascular disease who are at increased risk of future cardiovascular events including heart failure.

The best example of this is asymptomatic LVSD which is associated with a five-fold increased risk of developing heart failure with over half dying (most from cardiovascular causes) before they present with clinical heart failure [186]. This represents a missed opportunity to administer preventive therapy. Provided we can detect individuals with asymptomatic LVSD, there are evidence-based treatments available including ACE inhibitors, which have been shown to reduce the risk of developing heart failure and improve long-term survival compared with waiting for individuals to develop symptoms or signs of heart failure before starting treatment (see Table 3) [21, 22]. Guidelines also advocate for the use of beta blockers in such patients, especially if there is a history of previous myocardial infarction [46, 48, 51]. Implantable cardioverter defibrillator therapy may be considered to reduce the risk of sudden arrhythmic death if there is persisting severe LVSD despite optimal medical therapy [51]. Identification of asymptomatic LVSD may also lead to further diagnostic workup for underlying coronary artery disease, which would lead to additional preventive therapies if detected.

If we can accurately detect LVSD, it would seem reasonable to link this with the evidence from treatment efficacy studies conducted in subjects with asymptomatic LVSD to infer the clinical effectiveness of a screening strategy, provided the subjects detected through screening represent the same spectrum of disease as the patients enrolled in the clinical trials (see Figure 2) [140, 187]. However, given the limited availability of echocardiography and trained imaging staff, and the overall low prevalence of LVSD in the general community [40, 186, 188–195], a number of studies have evaluated the diagnostic accuracy of other methods to initially screen subjects including clinical risk scores, the 12-lead electrocardiogram, natriuretic peptides, and hand-held echocardiography [196–208]. Uncertainty remains regarding the best test (or combination of tests), how often these tests should be performed, and whether one should entirely focus on high-risk populations (e.g., based upon age, ethnicity, or associated diseases such as vascular disease or diabetes mellitus) rather than broad population screening to maximize cost effectiveness [196, 208–213].

Figure 2

In situations where we can reliably detect disease (e.g., left ventricular systolic dysfunction) in properly conducted diagnostic screening studies, coupled with high-level evidence (preferably from randomized, controlled trials) that we can improve clinical outcomes in individuals with the same disease in treatment efficacy studies, then we can link the two to determine the clinical effectiveness of a screening strategy. LVSD = left ventricular systolic dysfunction; ECG = electrocardiogram; SOLVD-P = studies of left ventricular dysfunction-prevention [21, 22].

Rather than limiting a screening strategy to identify asymptomatic LVSD, another approach is to screen for a number of structural cardiovascular derangements that are associated with an increased risk of developing heart failure including left atrial dilatation, LV diastolic dysfunction, LV hypertrophy, valvular heart disease, and aortic stiffness [200, 205, 214–218]. Indeed, it has been suggested that this would have the potential for greater population impact [218]. However, in the absence of treatment efficacy studies conducted in asymptomatic populations, this approach to population screening should ideally be assessed in a randomized, controlled trial to best define its clinical effectiveness and cost effectiveness [219].

7. Conclusion

Despite considerable advances in the treatment of heart failure over the last two to three decades, its prevalence continues to rise. Registries and population-based cohorts have revealed substantial gaps and variation in care. Multidisciplinary disease management brings us closer to the models of care that were applied in the randomized, controlled trials that guide our practice. More importantly, these programs improve quality of care, decrease mortality, and are cost effective in reducing hospitalizations in high-risk patients. However, to win the war, we also need to focus on disease prevention to reduce the human and economic burden imposed by heart failure. These strategies include addressing cardiovascular risk factors at a population level and screening for structural cardiovascular derangements such as asymptomatic LVSD.

Abbreviations

ACE inhibitors:	Angiotensin converting enzyme inhibitors
CRT:	Cardiac resynchronization therapy
LV:	Left ventricular
LVEF:	LV ejection fraction
LVSD:	LV systolic dysfunction.

Conflict of Interests

The author declared that there is no conflict of interests.

References

L. H. Curtis, D. J. Whellan, B. G. Hammill et al., “Incidence and prevalence of heart failure in elderly persons, 1994–2003,” Archives of Internal Medicine, vol. 168, no. 4, pp. 418–424, 2008.
View at: Publisher Site | Google Scholar
P. A. McCullough, E. F. Philbin, J. A. Spertus, S. Kaatz, K. R. Sandberg, and W. D. Weaver, “Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study,” Journal of the American College of Cardiology, vol. 39, no. 1, pp. 60–69, 2002.
View at: Publisher Site | Google Scholar
P. S. Jhund, K. MacIntyre, C. R. Simpson et al., “Long-term trends in first hospitalization for heart failure and subsequent survival between 1986 and 2003. A population study of 5.1 million people,” Circulation, vol. 119, no. 4, pp. 515–523, 2009.
View at: Publisher Site | Google Scholar
M. Schaufelberger, K. Swedberg, M. Köster, M. Rosén, and A. Rosengren, “Decreasing one-year mortality and hospitalization rates for heart failure in Sweden: data from the Swedish Hospital Discharge Registry 1988 to 2000,” European Heart Journal, vol. 25, no. 4, pp. 300–307, 2004.
View at: Publisher Site | Google Scholar
A. S. McLean, G. D. Eslick, and A. J. S. Coats, “The epidemiology of heart failure in Australia,” International Journal of Cardiology, vol. 118, no. 3, pp. 370–374, 2007.
View at: Publisher Site | Google Scholar
C. A. Wasywich, G. D. Gamble, G. A. Whalley, and R. N. Doughty, “Understanding changing patterns of survival and hospitalization for heart failure over two decades in New Zealand: utility of 'days alive and out of hospital' from epidemiological data,” European Journal of Heart Failure, vol. 12, no. 5, pp. 462–468, 2010.
View at: Publisher Site | Google Scholar
T. H. K. Teng, J. Finn, M. Hobbs, and J. Hung, “Heart failure: incidence, case fatality, and hospitalization rates in Western Australia between 1990 and 2005,” Circulation, vol. 3, no. 2, pp. 236–243, 2010.
View at: Publisher Site | Google Scholar
S. Stewart, K. MacIntyre, M. M. C. MacLeod, A. E. M. Bailey, S. Capewell, and J. J. V. McMurray, “Trends in hospitalization for heart failure in Scotland, 1990–1996. An epidemic that has reached its peak?” European Heart Journal, vol. 22, no. 3, pp. 209–217, 2001.
View at: Publisher Site | Google Scholar
J. McMurray, T. McDonagh, C. E. Morrison, and H. J. Dargie, “Trends in hospitalization for heart failure in Scotland 1980–1990,” European Heart Journal, vol. 14, no. 9, pp. 1158–1162, 1993.
View at: Google Scholar
H. Ni, D. J. Nauman, and R. E. Hershberger, “Analysis of trends in hospitalizations for heart failure,” Journal of Cardiac Failure, vol. 5, no. 2, pp. 79–84, 1999.
View at: Publisher Site | Google Scholar
T. H. K. Teng, J. Hung, M. Knuiman et al., “Trends in long-term cardiovascular mortality and morbidity in men and women with heart failure of ischemic versus non-ischemic aetiology in Western Australia between 1990 and 2005,” International Journal of Cardiology, vol. 158, pp. 405–410, 2012.
View at: Publisher Site | Google Scholar
H. M. Blackledge, J. Tomlinson, and I. B. Squire, “Prognosis for patients newly admitted to hospital with heart failure: survival trends in 12 220 index admissions in Leicestershire 1993–2001,” Heart, vol. 89, no. 6, pp. 615–620, 2003.
View at: Google Scholar
V. L. Roger, S. A. Weston, M. M. Redfield et al., “Trends in heart failure incidence and survival in a community-based population,” Journal of the American Medical Association, vol. 292, no. 3, pp. 344–350, 2004.
View at: Publisher Site | Google Scholar
D. Levy, S. Kenchaiah, M. Glarson et al., “Long-term trends in the incidence of and survival with heart failure,” The New England Journal of Medicine, vol. 347, no. 18, pp. 1397–1402, 2002.
View at: Publisher Site | Google Scholar
W. H. Barker, J. P. Mullooly, and W. Getchell, “Changing incidence and survival for heart failure in a well-defined older population, 1970–1974 and 1990–1994,” Circulation, vol. 113, no. 6, pp. 799–805, 2006.
View at: Publisher Site | Google Scholar
D. M. Lloyd-Jones, M. G. Larson, E. P. Leip et al., “Lifetime risk for developing congestive heart failure: the Framingham Heart Study,” Circulation, vol. 106, no. 24, pp. 3068–3072, 2002.
View at: Publisher Site | Google Scholar
G. S. Bleumink, A. M. Knetsch, M. C. J. M. Sturkenboom et al., “Quantifying the heart failure epidemic: prevalence, incidence rate, lifetime risk and prognosis of heart failure—the Rotterdam Study,” European Heart Journal, vol. 25, no. 18, pp. 1614–1619, 2004.
View at: Publisher Site | Google Scholar
S. Stewart, A. Jenkins, S. Buchan, A. McGuire, S. Capewell, and J. J. J. V. McMurray, “The current cost of heart failure to the National Health Service in the UK,” European Journal of Heart Failure, vol. 4, no. 3, pp. 361–371, 2002.
View at: Publisher Site | Google Scholar
L. Liao, L. A. Allen, and D. J. Whellan, “Economic burden of heart failure in the elderly,” PharmacoEconomics, vol. 26, no. 6, pp. 447–462, 2008.
View at: Publisher Site | Google Scholar
F. Braunschweig, M. R. Cowie, and A. Auricchio, “What are the costs of heart failure?” Europace, vol. 13, supplement 2, pp. ii13–ii17, 2011.
View at: Publisher Site | Google Scholar
P. Jong, S. Yusuf, M. F. Rousseau, S. A. Ahn, and S. I. Bangdiwala, “Effect of enalapril on 12-year survival and life expectancy in patients with left ventricular systolic dysfunction: a follow-up study,” The Lancet, vol. 361, no. 9372, pp. 1843–1848, 2003.
View at: Publisher Site | Google Scholar
The SOLVD Investigattors, “Effect of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left ventricular ejection fractions,” The New England Journal of Medicine, vol. 327, pp. 685–691, 1992.
View at: Publisher Site | Google Scholar
R. J. Goldberg, J. Ciampa, D. Lessard, T. E. Meyer, and F. A. Spencer, “Long-term survival after heart failure: a contemporary population-based perspective,” Archives of Internal Medicine, vol. 167, no. 5, pp. 490–496, 2007.
View at: Publisher Site | Google Scholar
S. Stewart, K. MacIntyre, D. J. Hole, S. Capewell, and J. J. V. McMurray, “More 'malignant' than cancer? Five-year survival following a first admission for heart failure,” European Journal of Heart Failure, vol. 3, no. 3, pp. 315–322, 2001.
View at: Publisher Site | Google Scholar
H. Bueno, J. S. Ross, Y. Wang et al., “Trends in length of stay and short-term outcomes among medicare patients hospitalized for heart failure, 1993–2006,” Journal of the American Medical Association, vol. 303, no. 21, pp. 2141–2147, 2010.
View at: Publisher Site | Google Scholar
S. F. Jencks, M. V. Williams, and E. A. Coleman, “Rehospitalizations among patients in the medicare fee-for-service program,” The New England Journal of Medicine, vol. 360, no. 14, pp. 1418–1428, 2009.
View at: Publisher Site | Google Scholar
D. E. Feldman, C. Thivierge, L. Guérard et al., “Changing trends in mortality and admissions to hospital for elderly patients with congestive heart failure in Montreal,” Canadian Medical Association Journal, vol. 165, no. 8, pp. 1033–1036, 2001.
View at: Google Scholar
M. Shafazand, M. Schaufelberger, G. Lappas, K. Swedberg, and A. Rosengren, “Survival trends in men and women with heart failure of ischaemic and non-ischaemic origin: data for the period 1987–2003 from the Swedish hospital discharge registry,” European Heart Journal, vol. 30, no. 6, pp. 671–678, 2009.
View at: Publisher Site | Google Scholar
D. S. Lee, M. M. Mamdani, P. C. Austin et al., “Trends in heart failure outcomes and pharmacotherapy: 1992 to 2000,” American Journal of Medicine, vol. 116, no. 9, pp. 581–589, 2004.
View at: Publisher Site | Google Scholar
J. Fang, G. A. Mensah, J. B. Croft, and N. L. Keenan, “Heart Failure-Related Hospitalization in the U.S., 1979 to 2004,” Journal of the American College of Cardiology, vol. 52, no. 6, pp. 428–434, 2008.
View at: Publisher Site | Google Scholar
H. Ni and R. E. Hershberger, “Was the decreasing trend in hospital mortality from heart failure attributable to improved hospital care? The Oregon experience, 1991–1995,” American Journal of Managed Care, vol. 5, no. 9, pp. 1105–1115, 1999.
View at: Google Scholar
C. A. Polanczyk, L. E. P. Rohde, G. W. Dec, and T. DiSalvo, “Ten-year trends in hospital care for congestive heart failure: improved outcomes and increased use of resources,” Archives of Internal Medicine, vol. 160, no. 3, pp. 325–332, 2000.
View at: Google Scholar
J. V. Tu, L. Nardi, J. Fang, J. Liu, L. Khalid, and H. Johansen, “National trends in rates of death and hospital admissions related to acute myocardial infarction, heart failure and stroke, 1994–2004,” Canadian Medical Association Journal, vol. 180, no. 13, pp. E118–E125, 2009.
View at: Publisher Site | Google Scholar
T. H. K. Teng, J. Hung, and J. Finn, “The effect of evidence-based medication use on long-term survival in patients hospitalised for heart failure in Western Australia,” Medical Journal of Australia, vol. 192, no. 6, pp. 306–310, 2010.
View at: Google Scholar
T. E. Owan, D. O. Hodge, R. M. Herges, S. J. Jacobsen, V. L. Roger, and M. M. Redfield, “Trends in prevalence and outcome of heart failure with preserved ejection fraction,” The New England Journal of Medicine, vol. 355, no. 3, pp. 251–259, 2006.
View at: Publisher Site | Google Scholar
“The survival of patients with heart failure with preserved or reduced left ventricular ejection fraction: an individual patient data meta-analysis,” European Heart Journal, vol. 33, pp. 1750–1757, 2012.
View at: Google Scholar
J. B. Somaratne, C. Berry, J. J. V. McMurray, K. K. Poppe, R. N. Doughty, and G. A. Whalley, “The prognostic significance of heart failure with preserved left ventricular ejection fraction: a literature-based meta-analysis,” European Journal of Heart Failure, vol. 11, no. 9, pp. 855–862, 2009.
View at: Publisher Site | Google Scholar
D. S. Lee, P. Gona, R. S. Vasan et al., “Relation of disease pathogenesis and risk factors to heart failure with preserved or reduced ejection fraction: insights from the framingham heart study of the national heart, lung, and blood institute,” Circulation, vol. 119, no. 24, pp. 3070–3077, 2009.
View at: Publisher Site | Google Scholar
R. S. Bhatia, J. V. Tu, D. S. Lee et al., “Outcome of heart failure with preserved ejection fraction in a population-based study,” The New England Journal of Medicine, vol. 355, no. 3, pp. 260–269, 2006.
View at: Publisher Site | Google Scholar
J. S. Gottdiener, R. L. McClelland, R. Marshall et al., “Outcome of congestive heart failure in elderly persons: influence of left ventricular systolic function. The cardiovascular health study,” Annals of Internal Medicine, vol. 137, no. 8, pp. 631–639, 2002.
View at: Google Scholar
J. F. Setaro, R. Soufer, M. S. Remetz, R. A. Perlmutter, and B. L. Zaret, “Long-term outcome in patients with congestive heart failure and intact systolic left ventricular performance,” American Journal of Cardiology, vol. 69, no. 14, pp. 1212–1216, 1992.
View at: Publisher Site | Google Scholar
B. R. Davis, J. B. Kostis, L. M. Simpson et al., “Heart failure with preserved and reduced left ventricular ejection fraction in the antihypertensive and lipid-lowering treatment to prevent heart attack trial,” Circulation, vol. 118, no. 22, pp. 2259–2267, 2008.
View at: Publisher Site | Google Scholar
R. S. Vasan, M. G. Larson, E. J. Benjamin, J. C. Evans, C. K. Reiss, and D. Levy, “Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction: prevalence and mortality in a population-based cohort,” Journal of the American College of Cardiology, vol. 33, no. 7, pp. 1948–1955, 1999.
View at: Publisher Site | Google Scholar
J. B. Braunstein, G. F. Anderson, G. Gerstenblith et al., “Noncardiac comorbidity increases preventable hospitalizations and mortality among medicare beneficiaries with chronic heart failure,” Journal of the American College of Cardiology, vol. 42, no. 7, pp. 1226–1233, 2003.
View at: Publisher Site | Google Scholar
S. M. Dunlay, M. M. Redfield, S. A. Weston et al., “Hospitalizations after heart failure diagnosis. A community perspective,” Journal of the American College of Cardiology, vol. 54, no. 18, pp. 1695–1702, 2009.
View at: Publisher Site | Google Scholar
H. Krum, M. V. Jelinek, S. Stewart, A. Sindone, and J. Atherton, “2011 Update to National Heart Foundation of Australian and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006,” Medical Journal of Australia, vol. 194, no. 8, pp. 405–409, 2011.
View at: Google Scholar
S. A. Hunt, W. T. Abraham, M. H. Chin et al., “ACC/AHA, 2005 Guideline Update for the Diagnosis and Management of Chronic Heart Failure in the Adult: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Update the 2001 Guidelines for the Evaluation and Management of Heart Failure): developed in collaboration with the American College of Chest Physicians and the International Society for Heart and Lung Transplantation: endorsed by the Heart Rhythm Society,” Circulation, vol. 112, pp. e154–e235, 2005.
View at: Google Scholar
K. Swedberg, J. Cleland, H. Dargie et al., “Guidelines for the diagnosis and treatment of chronic heart failure: executive summary (update 2005): the Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology,” European Heart Journal, vol. 26, pp. 1115–1140, 2005.
View at: Google Scholar
J. J. McMurray, S. Adamopoulos, S. D. Anker et al., “ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure 2012: The Task Force for the Diagnosis and Treatment of Acute and Chronic Heart Failure 2012 of the European Society of Cardiology. Developed in collaboration with the Heart Failure Association (HFA) of the ESC,” European Heart Journal, vol. 33, pp. 1787–1847, 2012.
View at: Google Scholar
H. Krum, M. V. Jelinek, S. Stewart, A. Sindone, and J. Atherton, “2011 Update to National Heart Foundation of Australian and Cardiac Society of Australia and New Zealand Guidelines for the prevention, detection and management of chronic heart failure in Australia, 2006,” Medical Journal of Australia, vol. 194, no. 8, pp. 405–409, 2011.
View at: Google Scholar
M. Jessup, W. T. Abraham, D. E. Casey et al., “2009 focused update: ACCF/AHA guidelines for the diagnosis and management of heart failure in adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation,” Circulation, vol. 119, no. 14, pp. 1977–2016, 2009.
View at: Publisher Site | Google Scholar
S. Yusuf, “Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure,” The New England Journal of Medicine, vol. 325, no. 5, pp. 293–302, 1991.
View at: Google Scholar
L. Køber, C. Torp-Pedersen, J. E. Carlsen et al., “A clinical trial of the angiotensin-converting-enzyme inhibitor trandolapril in patients with left ventricular dysfunction after myocardial infarction,” The New England Journal of Medicine, vol. 333, no. 25, pp. 1670–1676, 1995.
View at: Publisher Site | Google Scholar
M. A. Pfeffer, J. J. V. McMurray, E. J. Velazquez et al., “Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both,” The New England Journal of Medicine, vol. 349, no. 20, pp. 1893–1906, 2003.
View at: Publisher Site | Google Scholar
M. A. Pfeffer, E. Braunwald, L. A. Moye 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 New England Journal of Medicine, vol. 327, no. 10, pp. 669–677, 1992.
View at: Google Scholar
H. J. Dargie, “Effect of carvedilol on outcome after myocardial infarction in patients with left-ventricular dysfunction: the CAPRICORN randomised trial,” The Lancet, vol. 357, no. 9266, pp. 1385–1390, 2001.
View at: Publisher Site | Google Scholar
W. S. Colucci, T. J. Kolias, K. F. Adams et al., “Metoprolol reverses left ventricular remodeling in patients with asymptomatic systolic dysfunction: the REversal of VEntricular Remodeling with Toprol-XL (REVERT) Trial,” Circulation, vol. 116, no. 1, pp. 49–56, 2007.
View at: Publisher Site | Google Scholar
M. D. Flather, S. Yusuf, L. Køber et al., “Long-term ACE-inhibitor therapy in patients with heart failure or left-ventricular dysfunction: a systematic overview of data from individual patients,” The Lancet, vol. 355, no. 9215, pp. 1575–1581, 2000.
View at: Google Scholar
M. Packer, A. J. S. Coats, M. B. Fowler et al., “Effect of carvedilol on survival in severe chronic heart failure,” The New England Journal of Medicine, vol. 344, no. 22, pp. 1651–1658, 2001.
View at: Publisher Site | Google Scholar
“Effect of metoprolol CR/XL in chronic heart failure: metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF),” The Lancet, vol. 353, pp. 2001–2007, 1999.
View at: Google Scholar
H. J. Dargie and P. Lechat, “The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial,” The Lancet, vol. 353, no. 9146, pp. 9–13, 1999.
View at: Publisher Site | Google Scholar
F. Zannad, J. J. V. McMurray, H. Krum et al., “Eplerenone in patients with systolic heart failure and mild symptoms,” The New England Journal of Medicine, vol. 364, no. 1, pp. 11–21, 2011.
View at: Publisher Site | Google Scholar
B. Pitt, W. Remme, F. Zannad et al., “Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction,” The New England Journal of Medicine, vol. 348, no. 14, pp. 1309–1321, 2003.
View at: Publisher Site | Google Scholar
B. Pitt, F. Zannad, W. J. Remme et al., “The effect of spironolactone on morbidity and mortality in patients with severe heart failure,” The New England Journal of Medicine, vol. 341, no. 10, pp. 709–717, 1999.
View at: Publisher Site | Google Scholar
K. Swedberg, U. Idanpaan-Heikkila, and J. Remes, “Effects of enalapril on mortality in severe congestive heart failure. Results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS). The CONSENSUS Trial Study Group,” The New England Journal of Medicine, vol. 316, no. 23, pp. 1429–1435, 1987.
View at: Google Scholar
B. Pitt, P. A. Poole-Wilson, R. Segal et al., “Effect of losartan compared with captopril on mortality in patients with symptomatic heart failure: randomised trial—the Losartan Heart Failure Survival Study ELITE II,” The Lancet, vol. 355, no. 9215, pp. 1582–1587, 2000.
View at: Google Scholar
C. B. Granger, J. J. V. McMurray, S. Yusuf et al., “Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function intolerant to angiotensin-converting-enzyme inhibitors: the CHARM-alternative trial,” The Lancet, vol. 362, no. 9386, pp. 772–776, 2003.
View at: Publisher Site | Google Scholar
J. J. V. McMurray, J. Östergren, K. Swedberg et al., “Effects of candesartan in patients with chronic heart failure and reduced left-ventricular systolic function taking angiotensin-converting-enzyme inhibitors: the CHARM-added trial,” The Lancet, vol. 362, no. 9386, pp. 767–771, 2003.
View at: Publisher Site | Google Scholar
R. J. MacFadyen, A. F. C. Lee, J. J. Morton, S. D. Pringle, and A. D. Struthers, “How often are angiotensin II and aldosterone concentrations raised during chronic ACE inhibitor treatment in cardiac failure?” Heart, vol. 82, no. 1, pp. 57–61, 1999.
View at: Google Scholar
C. Borghi, S. Boschi, E. Ambrosioni, G. Melandri, A. Branzi, and B. Magnani, “Evidence of a partial escape of renin-angiotensin-aldosterone blockade in patients with acute myocardial infarction treated with ace inhibitors,” Journal of Clinical Pharmacology, vol. 33, no. 1, pp. 40–45, 1993.
View at: Google Scholar
D. N. Juurlink, M. M. Mamdani, D. S. Lee et al., “Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study,” The New England Journal of Medicine, vol. 351, pp. 543–551, 2004.
View at: Google Scholar
L. Wei, A. D. Struthers, T. Fahey, A. D. Watson, and T. M. Macdonald, “Spironolactone use and renal toxicity: population based longitudinal analysis,” British Medical Journal, vol. 340, article c1768, 2010.
View at: Publisher Site | Google Scholar
K. Swedberg, M. Komajda, M. Bohm, Ivabradine a et al., “nd outcomes in chronic heart failure (SHIFT): a randomised placebo-controlled study,” The Lancet, vol. 376, pp. 875–885, 2010.
View at: Publisher Site | Google Scholar
L. Tavazzi, A. P. Maggioni, R. Marchioli et al., “Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial,” The Lancet, vol. 372, no. 9645, pp. 1223–1230, 2008.
View at: Publisher Site | Google Scholar
S. D. Anker, J. C. Colet, G. Filippatos et al., “Ferric carboxymaltose in patients with heart failure and iron deficiency,” The New England Journal of Medicine, vol. 361, no. 25, pp. 2436–2448, 2009.
View at: Publisher Site | Google Scholar
A. L. Taylor, S. Ziesche, C. Yancy et al., “Combination of isosorbide dinitrate and hydralazine in blacks with heart failure,” The New England Journal of Medicine, vol. 351, no. 20, pp. 2049–2141, 2004.
View at: Publisher Site | Google Scholar
The Digitalis Investigation Group, “The effect of digoxin on mortality and morbidity in patients with heart failure,” The New England Journal of Medicine, vol. 336, pp. 525–533, 1997.
View at: Google Scholar
G. H. Bardy, K. L. Lee, D. B. Mark et al., “Amiodarone or an implantable cardioverter-defibrillator for congestive heart failure,” The New England Journal of Medicine, vol. 352, pp. 225–237, 2005.
View at: Google Scholar
A. J. Moss, W. Zareba, W. Jackson Hall et al., “Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction,” The New England Journal of Medicine, vol. 346, no. 12, pp. 877–883, 2002.
View at: Publisher Site | Google Scholar
S. M. Al-Khatib, K. J. Anstrom, E. L. Eisenstein et al., “Clinical and economic implications of the multicenter automatic defibrillator implantation trial-II,” Annals of Internal Medicine, vol. 142, no. 8, pp. 593–600, 2005.
View at: Google Scholar
G. D. Sanders, M. A. Hlatky, and D. K. Owens, “Cost-effectiveness of implantable cardioverter-defibrillators,” The New England Journal of Medicine, vol. 353, no. 14, pp. 1471–1480, 2005.
View at: Publisher Site | Google Scholar
J. Zwanziger, W. J. Hall, A. W. Dick et al., “The cost effectiveness of implantable cardioverter-defibrillators. Results from the Multicenter Automatic Defibrillator Implantation Trial (MADIT)-II,” Journal of the American College of Cardiology, vol. 47, no. 11, pp. 2310–2318, 2006.
View at: Publisher Site | Google Scholar
D. B. Mark, C. L. Nelson, K. J. Anstrom et al., “Cost-effectiveness of defibrillator therapy or amiodarone in chronic stable heart failure: results from the Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT),” Circulation, vol. 114, no. 2, pp. 135–142, 2006.
View at: Publisher Site | Google Scholar
MSAC Assessment Report: Implantable cardioverter defibrillators for prevention of sudden death. Medical Services Advisory Committee, Canberra, Australia 2006, http://www.msac.gov.au/internet/msac/publishing.nsf/Content/8FD1D98FE64C8A2FCA2575AD0082FD8F/$File/MSAC%20Ref%2032%20-%20ICDs.pdf.
D. Farwell, N. R. Patel, A. Hall, S. Ralph, and A. N. Sulke, “How many people with heart failure are appropriate for biventricular resynchronization?” European Heart Journal, vol. 21, no. 15, pp. 1246–1250, 2000.
View at: Publisher Site | Google Scholar
S. Cazeau, C. Leclercq, T. Lavergne et al., “Effects of multisite biventricular pacing in patients with heart failure and intraventricular conduction delay,” The New England Journal of Medicine, vol. 344, no. 12, pp. 873–880, 2001.
View at: Publisher Site | Google Scholar
J. B. Young, W. T. Abraham, A. L. Smith et al., “Combined cardiac resynchronization and implantable cardioversion defibrillation in advanced chronic heart failure: the MIRACLE ICD Trial,” Journal of the American Medical Association, vol. 289, no. 20, pp. 2685–2694, 2003.
View at: Publisher Site | Google Scholar
W. T. Abraham, W. G. Fisher, A. L. Smith et al., “Cardiac resynchronization in chronic heart failure,” The New England Journal of Medicine, vol. 346, pp. 1845–1853, 2002.
View at: Google Scholar
A. Auricchio, C. Stellbrink, S. Sack et al., “Long-term clinical effect of hemodynamically optimized cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay,” Journal of the American College of Cardiology, vol. 39, no. 12, pp. 2026–2033, 2002.
View at: Publisher Site | Google Scholar
C. Linde, C. Leclercq, S. Rex et al., “Long-term benefits of biventricular pacing in congestive heart failure: results from the MUltisite STimulation In Cardiomyopathy (MUSTIC) study,” Journal of the American College of Cardiology, vol. 40, no. 1, pp. 111–118, 2002.
View at: Publisher Site | Google Scholar
N. Freemantle, P. Tharmanathan, M. J. Calvert, W. T. Abraham, J. Ghosh, and J. G. F. Cleland, “Cardiac resynchronisation for patients with heart failure due to left ventricular systolic dysfunction—a systematic review and meta-analysis,” European Journal of Heart Failure, vol. 8, no. 4, pp. 433–440, 2006.
View at: Publisher Site | Google Scholar
A. S. L. Tang, G. A. Wells, M. Talajic et al., “Cardiac-resynchronization therapy for mild-to-moderate heart failure,” The New England Journal of Medicine, vol. 363, no. 25, pp. 2385–2395, 2010.
View at: Publisher Site | Google Scholar
G. Wells, R. Parkash, J. S. Healey et al., “Cardiac resynchronization therapy: a meta-analysis of randomized controlled trials,” Canadian Medical Association Journal, vol. 183, no. 4, pp. 421–429, 2011.
View at: Publisher Site | Google Scholar
M. R. Bristow, L. A. Saxon, J. Boehmer et al., “Cardiac-resynchronization therapy with or without an implantable defibrillator in advanced chronic heart failure,” The New England Journal of Medicine, vol. 350, no. 21, pp. 2140–2150, 2004.
View at: Publisher Site | Google Scholar
J. G. F. Cleland, J. C. Daubert, E. Erdmann et al., “The effect of cardiac resynchronization on morbidity and mortality in heart failure,” The New England Journal of Medicine, vol. 352, no. 15, pp. 1539–1549, 2005.
View at: Publisher Site | Google Scholar
G. C. Fonarow, J. T. Heywood, P. A. Heidenreich, M. Lopatin, and C. W. Yancy, “Temporal trends in clinical characteristics, treatments, and outcomes for heart failure hospitalizations, 2002 to 2004: findings from Acute Decompensated Heart Failure National Registry (ADHERE),” American Heart Journal, vol. 153, no. 6, pp. 1021–1028, 2007.
View at: Publisher Site | Google Scholar
M. S. Nieminen, D. Brutsaert, K. Dickstein et al., “EuroHeart Failure Survey II (EHFS II): a survey on hospitalized acute heart failure patients: description of population,” European Heart Journal, vol. 27, no. 22, pp. 2725–2736, 2006.
View at: Publisher Site | Google Scholar
J. J. Atherton, C. S. Hayward, W. A. Wan Ahmad et al., “Patient characteristics from a regional multicenter database of acute decompensated heart failure in Asia Pacific (ADHERE International-Asia Pacific),” Journal of Cardiac Failure, vol. 18, pp. 82–88, 2012.
View at: Google Scholar
G. C. Fonarow, W. T. Abraham, N. M. Albert et al., “Association between performance measures and clinical outcomes for patients hospitalized with heart failure,” Journal of the American Medical Association, vol. 297, no. 1, pp. 61–70, 2007.
View at: Publisher Site | Google Scholar
A. Michalsen, G. König, and W. Thimme, “Preventable causative factors leading to hospital admission with decompensated heart failure,” Heart, vol. 80, no. 5, pp. 437–441, 1998.
View at: Google Scholar
F. A. McAlister, S. Stewart, S. Ferrua, and J. J. J. V. McMurray, “Multidisciplinary strategies for the management of heart failure patients at high risk for admission: a systematic review of randomized trials,” Journal of the American College of Cardiology, vol. 44, no. 4, pp. 810–819, 2004.
View at: Publisher Site | Google Scholar
R. Holland, J. Battersby, I. Harvey, E. Lenaghan, J. Smith, and L. Hay, “Systematic review of multidisciplinary interventions in heart failure,” Heart, vol. 91, no. 7, pp. 899–906, 2005.
View at: Publisher Site | Google Scholar
M. W. Rich, V. Beckham, C. Wittenberg, C. L. Leven, K. E. Freedland, and R. M. Carney, “A multidisciplinary intervention to prevent the readmission of elderly patients with congestive heart failure,” The New England Journal of Medicine, vol. 333, no. 18, pp. 1190–1195, 1995.
View at: Publisher Site | Google Scholar
S. Stewart, J. E. Marley, and J. D. Horowitz, “Effects of a multidisciplinary, home-based intervention on unplanned readmissions and survival among patients with chronic congestive heart failure: a randomised controlled study,” The Lancet, vol. 354, no. 9184, pp. 1077–1083, 1999.
View at: Publisher Site | Google Scholar
C. O. Phillips, S. M. Wright, D. E. Kern, R. M. Singa, S. Shepperd, and H. R. Rubin, “Comprehensive discharge planning with postdischarge support for older patients with congestive heart failure: a meta-analysis,” Journal of the American Medical Association, vol. 291, no. 11, pp. 1358–1367, 2004.
View at: Publisher Site | Google Scholar
H. C. Wijeysundera, M. MacHado, X. Wang et al., “Cost-effectiveness of specialized multidisciplinary heart failure clinics in Ontario, Canada,” Value in Health, vol. 13, no. 8, pp. 915–921, 2010.
View at: Publisher Site | Google Scholar
D. S. F. Yu, D. R. Thompson, and D. T. F. Lee, “Disease management programmes for older people with heart failure: crucial characteristics which improve post-discharge outcomes,” European Heart Journal, vol. 27, no. 5, pp. 596–612, 2006.
View at: Publisher Site | Google Scholar
National Heart Foundation of Australia, Multidisciplinary care for people with chronic heart failure, Principles and recommendations for best practice, National Heart Foundation of Australia, Melbourne, Australia, 2010, http://www.heartfoundation.org.au/SiteCollectionDocuments/Multidisciplinary-care-for-people-with-CHF.pdf.
J. Suarez, J. P. Piccini, L. Liang et al., “International variation in use of oral anticoagulation among heart failure patients with atrial fibrillation,” American Heart Journal, vol. 163, pp. 804–811, 2012.
View at: Google Scholar
G. C. Fonarow, C. W. Yancy, and J. T. Heywood, “Adherence to heart failure quality-of-care indicators in US hospitals: analysis of the ADHERE registry,” Archives of Internal Medicine, vol. 165, no. 13, pp. 1469–1477, 2005.
View at: Publisher Site | Google Scholar
I. A. Scott, C. P. Denaro, J. L. Flores et al., “Quality of care of patients hospitalized with congestive heart failure,” Internal Medicine Journal, vol. 33, no. 4, pp. 140–151, 2003.
View at: Publisher Site | Google Scholar
N. M. Albert, C. W. Yancy, L. Liang et al., “Use of aldosterone antagonists in heart failure,” Journal of the American Medical Association, vol. 302, no. 15, pp. 1658–1665, 2009.
View at: Publisher Site | Google Scholar
D. S. Lee, J. V. Tu, D. N. Juurlink et al., “Risk-treatment mismatch in the pharmacotherapy of heart failure,” Journal of the American Medical Association, vol. 294, no. 10, pp. 1240–1247, 2005.
View at: Publisher Site | Google Scholar
J. P. Piccini, A. F. Hernandez, D. Dai et al., “Use of cardiac resynchronization therapy in patients hospitalized with heart failure,” Circulation, vol. 118, no. 9, pp. 926–933, 2008.
View at: Publisher Site | Google Scholar
J. G. F. Cleland, T. McDonagh, A. S. Rigby, A. Yassin, T. Whittaker, and H. J. Dargie, “The national heart failure audit for England and Wales 2008-2009,” Heart, vol. 97, no. 11, pp. 876–886, 2011.
View at: Publisher Site | Google Scholar
H. Krum, A. M. Tonkin, R. Currie, R. Djundjek, and C. Johnston, “Chronic heart failure in Australian general practice: the Cardiac Awareness Survey and Evaluation (CASE) study,” Medical Journal of Australia, vol. 174, no. 9, pp. 439–444, 2001.
View at: Google Scholar
J. G. F. Cleland, A. Cohen-Solal, J. C. Aguilar et al., “Management of heart failure in primary care (the Improvement of Heart Failure Programme): an international survey,” The Lancet, vol. 360, no. 9346, pp. 1631–1639, 2002.
View at: Publisher Site | Google Scholar
R. S. Stafford and D. C. Radley, “The underutilization of cardiac medications of proven benefit, 1990 to 2002,” Journal of the American College of Cardiology, vol. 41, no. 1, pp. 56–61, 2003.
View at: Publisher Site | Google Scholar
M. Komajda, P. Lapuerta, N. Hermans et al., “Adherence to guidelines is a predictor of outcome in chronic heart failure: the MAHLER survey,” European Heart Journal, vol. 26, no. 16, pp. 1653–1659, 2005.
View at: Publisher Site | Google Scholar
G. C. Fonarow, C. W. Yancy, N. M. Albert et al., “Heart failure care in the outpatient cardiology practice setting: findings from IMPROVE HF,” Circulation Heart failure, vol. 1, no. 2, pp. 98–106, 2008.
View at: Publisher Site | Google Scholar
G. C. Fonarow, W. T. Abraham, N. M. Albert et al., “Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the organized program to initiate lifesaving treatment in hospitalized patients with heart failure (OPTIMIZE-HF),” Archives of Internal Medicine, vol. 167, no. 14, pp. 1493–1502, 2007.
View at: Publisher Site | Google Scholar
K. F. Adams Jr., G. C. Fonarow, C. L. Emerman et al., “Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure National Registry (ADHERE),” American Heart Journal, vol. 149, no. 2, pp. 209–216, 2005.
View at: Publisher Site | Google Scholar
C. Tribouilloy, D. Rusinaru, H. Mahjoub, T. Goissen, F. Lévy, and M. Peltier, “Impact of echocardiography in patients hospitalized for heart failure: a prospective observational study,” Archives of Cardiovascular Diseases, vol. 101, no. 7-8, pp. 465–473, 2008.
View at: Publisher Site | Google Scholar
M. J. Calvert, A. Shankar, R. J. McManus, R. Ryan, and N. Freemantle, “Evaluation of the management of heart failure in primary care,” Family Practice, vol. 26, no. 2, pp. 145–153, 2009.
View at: Publisher Site | Google Scholar
M. Komajda, F. Follath, K. Swedberg et al., “The EuroHeart Failure survey programme—a survey on the quality of care among patients with heart failure in Europe. Part 2: treatment,” European Heart Journal, vol. 24, no. 5, pp. 464–474, 2003.
View at: Publisher Site | Google Scholar
G. Gelbrich, F. Edelmann, S. Inkrot et al., “Is target dose the treatment target? Uptitrating beta-blockers for heart failure in the elderly,” International Journal of Cardiology, vol. 155, pp. 160–166, 2012.
View at: Publisher Site | Google Scholar
M. B. Fowler, S. R. Lottes, J. J. Nelson et al., “β-Blocker dosing in community-based treatment of heart failure,” American Heart Journal, vol. 153, no. 6, pp. 1029–1036, 2007.
View at: Publisher Site | Google Scholar
G. C. Fonarow, W. T. Abraham, N. M. Albert et al., “Dosing of beta-blocker therapy before, during, and after hospitalization for heart failure (from organized program to initiate lifesaving treatment in hospitalized patients with heart failure),” American Journal of Cardiology, vol. 102, no. 11, pp. 1524–1529, 2008.
View at: Publisher Site | Google Scholar
G. H. Gislason, J. N. Rasmussen, S. Z. Abildstrom et al., “Persistent use of evidence-based pharmacotherapy in heart failure is associated with improved outcomes,” Circulation, vol. 116, no. 7, pp. 737–744, 2007.
View at: Publisher Site | Google Scholar
J. A. Franciosa, B. M. Massie, M. A. Lukas et al., “β-blocker therapy for heart failure outside the clinical trial setting: Findings of a community-based registry,” American Heart Journal, vol. 148, no. 4, pp. 718–726, 2004.
View at: Publisher Site | Google Scholar
H. D. Düngen, S. Apostolović, S. Inkrot et al., “Titration to target dose of bisoprolol vs. carvedilol in elderly patients with heart failure: The CIBIS-ELD trial,” European Journal of Heart Failure, vol. 13, no. 6, pp. 670–680, 2011.
View at: Publisher Site | Google Scholar
F. Gustafsson, M. Schou, L. Videbæk et al., “Treatment with beta-blockers in nurse-led heart failure clinics: Titration efficacy and predictors of failure,” European Journal of Heart Failure, vol. 9, no. 9, pp. 910–916, 2007.
View at: Publisher Site | Google Scholar
A. Driscoll, H. Krum, R. Wolfe, and A. Tonkin, “Nurse-led titration of β-adrenoreceptor blocking agents in chronic heart failure patients in the community,” Journal of Cardiac Failure, vol. 17, no. 3, pp. 224–230, 2011.
View at: Publisher Site | Google Scholar
P. A. Mehta, S. McDonagh, P. A. Poole-Wilson, R. Grocott-Mason, and S. W. Dubrey, “Heart failure in a district general hospital: are target doses of beta-blockers realistic?” QJM: Monthly Journal of the Association of Physicians, vol. 97, no. 3, pp. 133–139, 2004.
View at: Publisher Site | Google Scholar
A. Jain, P. Mills, L. M. Nunn et al., “Success of a multidisciplinary heart failure clinic for initiation and up-titration of key therapeutic agents,” European Journal of Heart Failure, vol. 7, no. 3, pp. 405–410, 2005.
View at: Publisher Site | Google Scholar
M. Lainscak, C. Moullet, N. Schön, and M. Tendera, “Treatment of chronic heart failure with carvedilol in daily practice: the SATELLITE survey experience,” International Journal of Cardiology, vol. 122, no. 2, pp. 149–155, 2007.
View at: Publisher Site | Google Scholar
P. Tandon, F. A. McAlister, R. T. Tsuyuki et al., “The use of β-blockers in a tertiary care heart failure clinic: dosing, tolerance, and outcomes,” Archives of Internal Medicine, vol. 164, no. 7, pp. 769–774, 2004.
View at: Publisher Site | Google Scholar
G. C. Fonarow, N. M. Albert, A. B. Curtis et al., “Associations between outpatient heart failure process-of-care measures and mortality,” Circulation, vol. 123, no. 15, pp. 1601–1610, 2011.
View at: Publisher Site | Google Scholar
S. A. Hunt, W. T. Abraham, M. H. Chin et al., “2009 focused update incorporated into the ACC/AHA, 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation,” Circulation, vol. 119, pp. e391–e479, 2009.
View at: Google Scholar
J. J. Atherton, “Stage B heart failure: rationale for screening,” Heart Failure Clinics, vol. 8, pp. 273–283, 2012.
View at: Publisher Site | Google Scholar
T. H. K. Teng, J. Finn, J. Hung, E. Geelhoed, and M. Hobbs, “A validation study: how effective is the Hospital Morbidity Data as a surveillance tool for heart failure in Western Australia?” Australian and New Zealand Journal of Public Health, vol. 32, no. 5, pp. 405–407, 2008.
View at: Publisher Site | Google Scholar
J. Langley, S. Stephenson, C. Thorpe, and G. Davie, “Accuracy of injury coding under ICD-9 for New Zealand public hospital discharges,” Injury Prevention, vol. 12, no. 1, pp. 58–61, 2006.
View at: Publisher Site | Google Scholar
T. Kümler, G. H. Gislason, V. Kirk et al., “Accuracy of a heart failure diagnosis in administrative registers,” European Journal of Heart Failure, vol. 10, no. 7, pp. 658–660, 2008.
View at: Publisher Site | Google Scholar
C. W. Yancy, M. Lopatin, L. W. Stevenson, T. De Marco, and G. C. Fonarow, “Clinical presentation, management, and in-hospital outcomes of patients admitted with acute decompensated heart failure with preserved systolic function: a report from the Acute Decompensated Heart Failure National Registry (ADHERE) Database,” Journal of the American College of Cardiology, vol. 47, pp. 76–84, 2006.
View at: Google Scholar
G. C. Fonarow, W. G. Stough, W. T. Abraham et al., “Characteristics, treatments, and outcomes of patients with preserved systolic function hospitalized for heart failure. A report from the OPTIMIZE-HF registry,” Journal of the American College of Cardiology, vol. 50, no. 8, pp. 768–777, 2007.
View at: Publisher Site | Google Scholar
T. E. Owan and M. M. Redfield, “Epidemiology of diastolic heart failure,” Progress in Cardiovascular Diseases, vol. 47, no. 5, pp. 320–332, 2005.
View at: Publisher Site | Google Scholar
C. S. P. Lam, E. Donal, E. Kraigher-Krainer, and R. S. Vasan, “Epidemiology and clinical course of heart failure with preserved ejection fraction,” European Journal of Heart Failure, vol. 13, no. 1, pp. 18–28, 2011.
View at: Publisher Site | Google Scholar
M. J. Lenzen, E. Boersma, W. J. M. Scholte Op Reimer et al., “Under-utilization of evidence-based drug treatment in patients with heart failure is only partially explained by dissimilarity to patients enrolled in landmark trials: a report from the Euro Heart Survey on Heart Failure,” European Heart Journal, vol. 26, no. 24, pp. 2706–2713, 2005.
View at: Publisher Site | Google Scholar
W. A. Gattis, C. M. O'Connor, D. S. Gallup, V. Hasselblad, and M. Gheorghiade, “Predischarge initiation of carvedilol in patients hospitalized for decompensated heart failure: results of the initiation management predischarge: process for assessment of carvedilol therapy in heart failure (IMPACT-HF) trial,” Journal of the American College of Cardiology, vol. 43, no. 9, pp. 1534–1541, 2004.
View at: Publisher Site | Google Scholar
L. Baruch and R. A. Phillips, “Quality: the need for intelligent efforts,” Archives of Internal Medicine, vol. 165, no. 13, pp. 1455–1456, 2005.
View at: Publisher Site | Google Scholar
G. C. Fonarow, “Improving quality of care and outcomes for heart failure: role of registries,” Circulation Journal, vol. 75, no. 8, pp. 1783–1790, 2011.
View at: Publisher Site | Google Scholar
G. C. Fonarow, N. M. Albert, A. B. Curtis et al., “Improving evidence-based care for heart failure in outpatient cardiology practices: primary results of the registry to improve the use of evidence-based heart failure therapies in the outpatient setting (IMPROVE HF),” Circulation, vol. 122, no. 6, pp. 585–596, 2010.
View at: Publisher Site | Google Scholar
P. A. Heidenreich, W. R. Lewis, K. A. LaBresh, L. H. Schwamm, and G. C. Fonarow, “Hospital performance recognition with the Get With The Guidelines Program and mortality for acute myocardial infarction and heart failure,” American Heart Journal, vol. 158, no. 4, pp. 546–553, 2009.
View at: Publisher Site | Google Scholar
J. J. Atherton, A. Hickey, and J. Suna, “Striving to achieve best practice in heart failure disease management,” BMJ Quality and Safety, vol. 21, article 263, 2012.
View at: Google Scholar
H. Krum, J. Hill, F. Fruhwald et al., “Tolerability of beta-blockers in elderly patients with chronic heart failure: the COLA II study,” European Journal of Heart Failure, vol. 8, no. 3, pp. 302–307, 2006.
View at: Publisher Site | Google Scholar
I. Ekman, B. Fagerberg, B. Andersson, G. Matejka, and B. Persson, “Can treatment with angiotensin-converting enzyme inhibitors in elderly patients with moderate to severe chronic heart failure be improved by a nurse-monitored structured care program? A randomized controlled trial,” Heart and Lung, vol. 32, no. 1, pp. 3–9, 2003.
View at: Publisher Site | Google Scholar
M. Ansari, M. G. Shlipak, P. A. Heidenreich et al., “Improving guideline adherence: a randomized trial evaluating strategies to increase β-blocker use in heart failure,” Circulation, vol. 107, no. 22, pp. 2799–2804, 2003.
View at: Publisher Site | Google Scholar
A. Hickey, J. Suna, L. Marquart, C. P. Denaro, G. Javorsky, and J. Atherton, “Predictors of therapeutic dose achievement in the management of heart failure,” Heart Lung Circulation, vol. 21, supplement 1, pp. S87–S88, 2012.
View at: Google Scholar
S. C. Inglis, R. A. Clark, F. A. McAlister et al., “Structured telephone support or telemonitoring programmes for patients with chronic heart failure,” Cochrane Database of Systematic Reviews, vol. 8, Article ID CD007228, 2010.
View at: Google Scholar
R. A. Clark, S. C. Inglis, F. A. McAlister, J. G. F. Cleland, and S. Stewart, “Telemonitoring or structured telephone support programmes for patients with chronic heart failure: systematic review and meta-analysis,” British Medical Journal, vol. 334, no. 7600, pp. 942–945, 2007.
View at: Publisher Site | Google Scholar
S. I. Chaudhry, J. A. Mattera, J. P. Curtis et al., “Telemonitoring in patients with heart failure,” The New England Journal of Medicine, vol. 363, no. 24, pp. 2301–2309, 2010.
View at: Publisher Site | Google Scholar
F. Koehler, S. Winkler, M. Schieber et al., “Impact of remote telemedical management on mortality and hospitalizations in ambulatory patients with chronic heart failure: the telemedical interventional monitoring in heart failure study,” Circulation, vol. 123, no. 17, pp. 1873–1880, 2011.
View at: Publisher Site | Google Scholar
S. I. Chaudhry, Y. Wang, J. Concato, T. M. Gill, and H. M. Krumholz, “Patterns of weight change preceding hospitalization for heart failure,” Circulation, vol. 116, no. 14, pp. 1549–1554, 2007.
View at: Publisher Site | Google Scholar
J. Zhang, K. M. Goode, P. E. Cuddihy, and J. G. F. Cleland, “Predicting hospitalization due to worsening heart failure using daily weight measurement: analysis of the Trans-European Network-Home-Care Management System (TEN-HMS) study,” European Journal of Heart Failure, vol. 11, no. 4, pp. 420–427, 2009.
View at: Publisher Site | Google Scholar
J. Lewin, M. Ledwidge, C. O'Loughlin, C. McNally, and K. McDonald, “Clinical deterioration in established heart failure: what is the value of BNP and weight gain in aiding diagnosis?” European Journal of Heart Failure, vol. 7, no. 6, pp. 953–957, 2005.
View at: Publisher Site | Google Scholar
P. Porapakkham, P. Porapakkham, H. Zimmet, B. Billah, and H. Krum, “B-type natriuretic peptide-guided heart failure therapy: a meta-analysis,” Archives of Internal Medicine, vol. 170, no. 6, pp. 507–514, 2010.
View at: Google Scholar
G. M. Felker, V. Hasselblad, A. F. Hernandez, and C. M. O'Connor, “Biomarker-guided therapy in chronic heart failure: a meta-analysis of randomized controlled trials,” American Heart Journal, vol. 158, no. 3, pp. 422–430, 2009.
View at: Publisher Site | Google Scholar
C. M. Yu, L. Wang, E. Chau et al., “Intrathoracic impedance monitoring in patients with heart failure: correlation with fluid status and feasibility of early warning preceding hospitalization,” Circulation, vol. 112, no. 6, pp. 841–848, 2005.
View at: Publisher Site | Google Scholar
C. Ypenburg, J. J. Bax, E. E. van der Wall, M. J. Schalij, and L. van Erven, “Intrathoracic impedance monitoring to predict decompensated heart failure,” American Journal of Cardiology, vol. 99, no. 4, pp. 554–557, 2007.
View at: Publisher Site | Google Scholar
P. B. Adamson, A. Magalski, F. Braunschweig et al., “Ongoing right ventricular hemodynamics in heart failure: clinical value of measurements derived from an implantable monitoring system,” Journal of the American College of Cardiology, vol. 41, no. 4, pp. 565–571, 2003.
View at: Publisher Site | Google Scholar
M. R. Zile, T. D. Bennett, S. M. S. John et al., “Transition from chronic compensated to acute d compensated heart failure: pathophysiological insights obtained from continuous monitoring of intracardiac pressures,” Circulation, vol. 118, no. 14, pp. 1433–1441, 2008.
View at: Publisher Site | Google Scholar
J. Ritzema, R. Troughton, I. Melton et al., “Physician-directed patient self-management of left atrial pressure in advanced chronic heart failure,” Circulation, vol. 121, no. 9, pp. 1086–1095, 2010.
View at: Publisher Site | Google Scholar
V. M. Conraads, L. Tavazzi, M. Santini et al., “Sensitivity and positive predictive value of implantable intrathoracic impedance monitoring as a predictor of heart failure hospitalizations: the SENSE-HF trial,” European Journal of Heart Failure, vol. 32, pp. 2266–2273, 2011.
View at: Google Scholar
D. J. van Veldhuisen, F. Braunschweig, V. Conraads et al., “Intrathoracic impedance monitoring, audible patient alerts, and outcome in patients with heart failure,” Circulation, vol. 124, pp. 1719–1726, 2011.
View at: Google Scholar
W. T. Abraham, P. B. Adamson, R. C. Bourge et al., “Wireless pulmonary artery haemodynamic monitoring in chronic heart failure: a randomised controlled trial,” The Lancet, vol. 377, no. 9766, pp. 658–666, 2011.
View at: Publisher Site | Google Scholar
S. Yusuf, M. A. Pfeffer, K. Swedberg et al., “Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-preserved trial,” The Lancet, vol. 362, no. 9386, pp. 777–781, 2003.
View at: Publisher Site | Google Scholar
J. G. F. Cleland, M. Tendera, J. Adamus, N. Freemantle, L. Polonski, and J. Taylor, “The perindopril in elderly people with chronic heart failure (PEP-CHF) study,” European Heart Journal, vol. 27, no. 19, pp. 2338–2345, 2006.
View at: Publisher Site | Google Scholar
B. M. Massie, P. E. Carson, J. J. McMurray et al., “Irbesartan in patients with heart failure and preserved ejection fraction,” The New England Journal of Medicine, vol. 359, no. 23, pp. 2456–2467, 2008.
View at: Publisher Site | Google Scholar
A. S. Desai, E. F. Lewis, R. Li et al., “Rationale and design of the treatment of preserved cardiac function heart failure with an aldosterone antagonist trial: a randomized, controlled study of spironolactone in patients with symptomatic heart failure and preserved ejection fraction,” American Heart Journal, vol. 162, pp. 966–972.e10, 2011.
View at: Publisher Site | Google Scholar
K. A. Ammar, S. J. Jacobsen, D. W. Mahoney et al., “Prevalence and prognostic significance of heart failure stages: application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community,” Circulation, vol. 115, no. 12, pp. 1563–1570, 2007.
View at: Publisher Site | Google Scholar
D. J. Campbell, “Heart failure: how can we prevent the epidemic?” Medical Journal of Australia, vol. 179, no. 8, pp. 422–425, 2003.
View at: Google Scholar
M. R. Law, J. K. Morris, and N. J. Wald, “Use of blood pressure lowering drugs in the prevention of cardiovascular disease: meta-analysis of 147 randomised trials in the context of expectations from prospective epidemiological studies,” British Medical Journal, vol. 338, article b1665, 2009.
View at: Publisher Site | Google Scholar
K. Wilson, N. Gibson, A. Willan, and D. Cook, “Effect of smoking cessation on mortality after myocardial infarction: meta-analysis of cohort studies,” Archives of Internal Medicine, vol. 160, no. 7, pp. 939–944, 2000.
View at: Google Scholar
B. Mihaylova, J. Emberson, L. Blackwell et al., “The effects of lowering LDL cholesterol with statin therapy in people at low risk of vascular disease: meta-analysis of individual data from 27 randomised trials,” The Lancet, vol. 380, pp. 581–590, 2012.
View at: Google Scholar
C. Baigent, A. Keech, P. M. Kearney et al., “Efficacy and safety of cholesterol-lowering treatment: prospective meta-analysis of data from 90,056 participants in 14 randomised trials of statins,” The Lancet, vol. 366, pp. 1267–1278, 2005.
View at: Google Scholar
T. J. Wang, J. C. Evans, E. J. Benjamin, D. Levy, E. C. LeRoy, and R. S. Vasan, “Natural history of asymptomatic left ventricular systolic dysfunction in the community,” Circulation, vol. 108, no. 8, pp. 977–982, 2003.
View at: Publisher Site | Google Scholar
S. J. Lord, L. Irwig, and R. J. Simes, “When is measuring sensitivity and specificity sufficient to evaluate a diagnostic test, and when do we need randomized trials?” Annals of Internal Medicine, vol. 144, no. 11, pp. 850–855, 2006.
View at: Google Scholar
T. A. McDonagh, C. E. Morrison, A. Lawrence et al., “Symptomatic and asymptomatic left-ventricular systolic dysfunction in an urban population,” The Lancet, vol. 350, no. 9081, pp. 829–833, 1997.
View at: Publisher Site | Google Scholar
H. Schunkert, U. Broeckel, H. W. Hense, U. Keil, and G. A. Riegger, “Left-ventricular dysfunction,” The Lancet, vol. 351, no. 9099, p. 372, 1998.
View at: Google Scholar
A. Mosterd, A. W. Hoes, M. C. De Bruyne et al., “Prevalence of heart failure and left ventricular dysfunction in the general population. The Rotterdam Study,” European Heart Journal, vol. 20, no. 6, pp. 447–455, 1999.
View at: Publisher Site | Google Scholar
M. K. Davies, F. D. R. Hobbs, R. C. Davis et al., “Prevalence of left-ventricular systolic dysfunction and heart failure in the Echocardiographic Heart of England Screening study: a population based study,” The Lancet, vol. 358, no. 9280, pp. 439–444, 2001.
View at: Publisher Site | Google Scholar
R. B. Devereux, M. J. Roman, M. Paranicas et al., “A population-based assessment of left ventricular systolic dysfunction in middle-aged and older adults: the Strong Heart Study,” American Heart Journal, vol. 141, no. 3, pp. 439–446, 2001.
View at: Publisher Site | Google Scholar
M. M. Redfield, S. J. Jacobsen, J. C. Burnett, D. W. Mahoney, K. R. Bailey, and R. J. Rodeheffer, “Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic,” Journal of the American Medical Association, vol. 289, no. 2, pp. 194–202, 2003.
View at: Publisher Site | Google Scholar
W. P. Abhayaratna, W. T. Smith, T. H. Marwick, I. M. Jeffrey, and D. A. McGill, “Prevalence of heart failure and systolic ventricular dysfunction in older Australians: the Canberra heart study,” Medical Journal of Australia, vol. 184, no. 4, pp. 151–154, 2006.
View at: Google Scholar
K. Bibbins-Dorningo, M. J. Pletcher, F. Lin et al., “Racial differences in incident heart failure among young adults,” The New England Journal of Medicine, vol. 360, no. 12, pp. 1179–1190, 2009.
View at: Publisher Site | Google Scholar
G. I. W. Galasko, S. C. Barnes, P. Collinson, A. Lahiri, and R. Senior, “What is the most cost-effective strategy to screen for left ventricular systolic dysfunction: natriuretic peptides, the electrocardiogram, hand-held echocardiography, traditional echocardiography, or their combination?” European Heart Journal, vol. 27, no. 2, pp. 193–200, 2006.
View at: Publisher Site | Google Scholar
L. L. Ng, B. Pathik, I. W. Loke, I. B. Squire, and J. E. Davies, “Myeloperoxidase and C-reactive protein augment the specificity of B-type natriuretic peptide in community screening for systolic heart failure,” American Heart Journal, vol. 152, no. 1, pp. 94–101, 2006.
View at: Publisher Site | Google Scholar
E. C. Vourvouri, A. F. L. Schinkel, J. R. T. C. Roelandt et al., “Screening for left ventricular dysfunction using a hand-carried cardiac ultrasound device,” European Journal of Heart Failure, vol. 5, no. 6, pp. 767–774, 2003.
View at: Publisher Site | Google Scholar
L. L. Ng, I. W. Loke, J. E. Davies et al., “Community screening for left ventricular systolic dysfunction using plasma and urinary natriuretic peptides,” Journal of the American College of Cardiology, vol. 45, no. 7, pp. 1043–1050, 2005.
View at: Publisher Site | Google Scholar
M. M. Redfield, R. J. Rodeheffer, S. J. Jacobsen, D. W. Mahoney, K. R. Bailey, and J. C. Burnett Jr., “Plasma brain natriuretic peptide to detect preclinical ventricular systolic or diastolic dysfunction: a community-based study,” Circulation, vol. 109, no. 25, pp. 3176–3181, 2004.
View at: Google Scholar
P. A. Heidenreich, M. A. Gubens, G. C. Fonarow, M. A. Konstam, L. W. Stevenson, and P. G. Shekelle, “Cost-effectiveness of screening with B-type natriuretic peptide to identify patients with reduced left ventricular ejection fraction,” Journal of the American College of Cardiology, vol. 43, no. 6, pp. 1019–1026, 2004.
View at: Publisher Site | Google Scholar
J. Latour-Pérez, F. J. Coves-Orts, C. Abad-Terrado, V. Abraira, and J. Zamora, “Accuracy of B-type natriuretic peptide levels in the diagnosis of left ventricular dysfunction and heart failure: a systematic review,” European Journal of Heart Failure, vol. 8, no. 4, pp. 390–399, 2006.
View at: Publisher Site | Google Scholar
B. Ewald, D. Ewald, A. Thakkinstian, and J. Attia, “Meta-analysis of B type natriuretic peptide and N-terminal pro B natriuretic peptide in the diagnosis of clinical heart failure and population screening for left ventricular systolic dysfunction,” Internal Medicine Journal, vol. 38, no. 2, pp. 101–113, 2008.
View at: Publisher Site | Google Scholar
C. Davenport, E. Y. L. Cheng, Y. T. T. Kwok et al., “Assessing the diagnostic test accuracy of natriuretic peptides and ECG in the diagnosis of left ventricular systolic dysfunction: a systematic review and meta-analysis,” British Journal of General Practice, vol. 56, no. 522, pp. 48–56, 2006.
View at: Google Scholar
R. S. Vasan, E. J. Benjamin, M. G. Larson et al., “Plasma natriuretic peptides for community screening for left ventricular hypertrophy and systolic dysfunction: the Framingham heart study,” Journal of the American Medical Association, vol. 288, no. 10, pp. 1252–1259, 2002.
View at: Google Scholar
V. Madhok, G. Falk, A. Rogers, A. D. Struthers, F. M. Sullivan, and T. Fahey, “The accuracy of symptoms, signs and diagnostic tests in the diagnosis of left ventricular dysfunction in primary care: a diagnostic accuracy systematic review,” BMC Family Practice, vol. 9, article 56, 2008.
View at: Publisher Site | Google Scholar
T. A. McDonagh, S. Holmer, I. Raymond, A. Luchner, P. Hildebrant, and H. J. Dargie, “NT-proBNP and the diagnosis of heart failure: a pooled analysis of three European epidemiological studies,” European Journal of Heart Failure, vol. 6, no. 3, pp. 269–273, 2004.
View at: Publisher Site | Google Scholar
J. J. Atherton, “Screening for left ventricular systolic dysfunction: is imaging a solution?” JACC Cardiovascular Imaging, vol. 3, no. 4, pp. 421–428, 2010.
View at: Publisher Site | Google Scholar
F. Yousaf, J. Collerton, A. Kingston et al., “Prevalence of left ventricular dysfunction in a UK community sample of very old people: the Newcastle 85+ study,” Heart, vol. 98, pp. 1418–1423, 2012.
View at: Publisher Site | Google Scholar
M. McGrady, H. Krum, M. J. Carrington et al., “Heart failure, ventricular dysfunction and risk factor prevalence in Australian Aboriginal peoples: the Heart of the Heart Study,” Heart, vol. 98, no. 21, pp. 1562–1567, 2012.
View at: Google Scholar
R. Kelly and A. D. Struthers, “Screening for left ventricular systolic dysfunction in patients with stroke, transient ischaemic attacks, and peripheral vascular disease,” QJM: Monthly Journal of the Association of Physicians, vol. 92, no. 6, pp. 295–297, 1999.
View at: Google Scholar
M. A. Silver and C. Pisano, “High incidence of elevated B-type natriuretic peptide levels and risk factors for heart failure in an unselected at-risk population (stage A): implications for heart failure screening programs,” Congestive Heart Failure, vol. 9, no. 3, pp. 127–132, 2003.
View at: Google Scholar
L. J. Boonman-de Winter, F. H. Rutten, M. J. Cramer et al., “High prevalence of previously unknown heart failure and left ventricular dysfunction in patients with type 2 diabetes,” Diabetologia, vol. 55, pp. 2154–2162, 2012.
View at: Publisher Site | Google Scholar
M. Nakamura, H. Endo, M. Nasu, N. Arakawa, T. Segawa, and K. Hiramori, “Value of plasma B type natriuretic peptide measurement for heart disease screening in a Japanese population,” Heart, vol. 87, no. 2, pp. 131–135, 2002.
View at: Google Scholar
G. I. W. Galasko, A. Lahiri, and R. Senior, “Portable echocardiography: an innovative tool in screening for cardiac abnormalities in the community,” European Journal of Echocardiography, vol. 4, no. 2, pp. 119–127, 2003.
View at: Publisher Site | Google Scholar
Y. Takemoto, M. E. Barnes, J. B. Seward et al., “Usefulness of left atrial volume in predicting first congestive heart failure in patients < or = 65 years of age with well-preserved left ventricular systolic function,” American Journal of Cardiology, vol. 96, no. 6, pp. 832–836, 2005.
View at: Publisher Site | Google Scholar
G. P. Aurigemma, J. S. Gottdiener, L. Shemanski, J. Gardin, and D. Kitzman, “Predictive value of systolic and diastolic function for incident congestive heart failure in the elderly: the cardiovascular health study,” Journal of the American College of Cardiology, vol. 37, no. 4, pp. 1042–1048, 2001.
View at: Publisher Site | Google Scholar
D. A. Duprez, N. Florea, W. Zhong et al., “Vascular and cardiac functional and structural screening to identify risk of future morbid events: preliminary observations,” Journal of the American Society of Hypertension, vol. 5, pp. 401–409, 2011.
View at: Publisher Site | Google Scholar
P. S. Douglas, A. Taylor, D. Bild et al., “Outcomes research in cardiovascular imaging report of a workshop sponsored by the national heart, lung, and blood institute,” Circulation, vol. 2, no. 4, pp. 339–348, 2009.
View at: Publisher Site | Google Scholar

Copyright

Copyright © 2012 John J. Atherton. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

PDF Download Citation

Download other formats

Order printed copies

Views

4277

Downloads

1632

Citations