Education and debate

Fortnightly Review: Diagnosis and management of heart failure

BMJ 1994; 308 doi: 10.1136/bmj.308.6924.321 (Published 29 January 1994)
Cite this as: BMJ 1994;308:321

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  1. H J Dargie,
  2. J J V McMurray
  1. Department of Cardiology, Western Infirmary, Glasgow G11 6NT Cardiac
  2. Department, Western General Hospital, Edinburgh EH4 2XU.
  • Accepted 14 October 1993

Summary points

  • Summary points

  • Heart failure is a malignant condition with high rates of morbidity and mortality even in so called mild cases

  • Left ventricular dysfunction is the main cause of heart failure, and echocardiography can quickly distinguish less common but reversible causes

  • The most effective medical treatments for heart failure are diuretics, usually a loop diuretic, and angiotensin converting enzyme inhibitors

  • If patients remain symptomatic or cannot tolerate angiotensin converting enzyme inhibitors, other treatments such as hydralazine and isosorbide dinitrate or digoxin may be used, and as a last resort cardiac transplantation may be considered

  • Concomitant problems that may need treatment are atrial fibrillation, angina, and ventricular arrhythmia

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

Heart failure is a serious public health problem, with a prevalence in the United Kingdom, Scandinavia, and the …

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