Intended for healthcare professionals

Clinical Review Recent developments

Management of chronic heart failure

BMJ 2002; 325 doi: (Published 24 August 2002) Cite this as: BMJ 2002;325:422
  1. Martin R Cowie (, professor of cardiology,
  2. Alex Zaphiriou, clinical research fellow
  1. Cardiac Medicine, National Heart and Lung Institute, Faculty of Medicine, Imperial College, London SW3 6LY
  1. Correspondence to: M R Cowie

    Heart failure is a complex syndrome that results from any structural or functional cardiac disorder that impairs the ability of the heart to function as a pump. It has a major impact on longevity and quality of life. One to two per cent of the general population of developed countries have heart failure, and the average age at diagnosis is 76 years.1 Although the steady rise in hospital admissions for heart failure has slowed recently, the management of heart failure still accounts for 1-2% of healthcare expenditure in the United Kingdom and other countries in the developed world.2 Improvements in cardiac imaging and new biochemical assays have made diagnosis more straightforward. Major changes in treatment have resulted from a better understanding of the pathophysiology of heart failure and the results of large clinical trials. Improving outcomes now increasingly depends on improved communication between healthcare professionals, education of patients and carers, and better chronic disease management.

    Sources and search criteria

    We searched the PubMed database for publications on the diagnosis and treatment of chronic heart failure in adult humans. We also consulted recent international guidelines to develop an overview of the evidence based management of heart failure.

    Fig 1

    Algorithm for the diagnosis of heart failure (based on the most recent guidelines from the European Society of Cardiology)3


    Heart failure is usually associated with dyspnoea, fatigue, and fluid retention. Symptoms alone cannot be relied on in making the diagnosis: a careful history and physical examination need to be supplemented by further tests. Diagnosis requires consideration of the underlying abnormality of the heart, the severity of the syndrome, the aetiology, the precipitating and exacerbating factors, the identification of concomitant disease relevant to management, and an estimation of prognosis. Figure 1 shows the algorithm for the diagnosis of heart failure currently recommended by the European Society …

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