Abstract:
Congestive heart failure is a common condition that increases in prevalence with increasing age. In 2003, guidance from the National Institute for Health and Clinical Excellence acknowledged that the “rising epidemic of heart failure” is partly the result of people living longer and the more effective treatments for coronary heart disease now available. It also acknowledged, however, that average life expectancy is only about three years after diagnosis, which is much worse than for many other serious illnesses such as cancer of the breast or colon.1 The condition is associated with poor quality of life, frequent hospital admissions, and poor survival,2 although this may have changed with the advent of better treatments. Community estimates of prevalence vary from 1.6 to 4.6 cases per 1000 in men aged 45-74 years and from 0.9 to 2.2 cases per 1000 in women. About 1% of men develop heart failure after age 75 and almost 2% after 80 years.3 This review discusses the immediate management of patients who present with the clinical syndrome of heart failure (usually a combination of dyspnoea, fatigue, exercise intolerance, and fluid retention) and the management of chronic congestive heart failure. It is based on evidence from guidelines, randomised controlled trials, and population cohorts followed for many years. We also emphasise the distinction between heart failure with low ejection fraction and heart failure with preserved ejection fraction because although plenty of evidence exists on how to treat the first entity very little exists on how to treat the second.