Heart failure is the end stage of all diseases of the heart and is a major cause of morbidity and mortality. It is estimated to account for about 5% of admissions to hospital medical wards, with over 100 000 annual admissions in the United Kingdom. The overall prevalence of heart failure is 3 20 per 1000 population, although this exceeds 100 per 1000 in those aged 65 years and over. The annual incidence of heart failure is 1 5 per 1000, and the relative incidence doubles for each decade of life after the age of 45 years. The overall incidence is likely to increase in the future, because of both an ageing population and therapeutic advances in the management of acute myocardial infarction leading to improved survival in patients with impaired cardiac function. Unfortunately, heart failure can be difficult to diagnose clinically, as many features of the condition are not organ specific, and there may be few clinical features in the early stages of the disease. Recent advances have made the early recognition of heart failure increasingly important as modern drug treatment has the potential to improve symptoms and quality of life, reduce hospital admission rates, slow the rate of disease progression, and improve survival. In addition, coronary revascularisation and heart valve surgery are now regularly performed, even in elderly patients.
A brief history Descriptions of heart failure exist from ancient Egypt, Greece, and India, and the Romans were known to use the foxglove as medicine. Little understanding of the nature of the condition can have existed until William Harvey described the circulation in 1628. Röntgen’s discovery of x rays and Einthoven’s development of electrocardiography in the 1890s led to improvements in the investigation of heart failure. The advent of echocardiography, cardiac catheterisation, and nuclear medicine have since improved the diagnosis and investigation of patients with heart failure.