Foreword
Medizinische Klinik III der Universität zu Köln, Kerpener Straße 62, D-50937 Köln, Germany
* Corresponding author. Tel: +49 221 478 4503; fax: +49 221 478 6275. E-mail address: erland.erdmann{at}uni-koeln.de
Chronic heart failure (CHF) is a debilitating condition associated with a poor long-term prognosis, reduced quality of life, and considerable economic costs.1–3 It is particularly prevalent among the elderly and represents the leading cause of hospitalization in older adults.1 Owing to the ageing of the global population and advances in medical technologies that have enabled more patients to survive following myocardial infarction, CHF represents the only major cardiovascular disease whose prevalence, incidence, and associated mortality are reported to be increasing in industrialized nations.4
Numerous effective pharmacological agents are available for the treatment of patients with CHF. However, many patients, and particularly the elderly, do not receive optimum pharmacological treatments. In addition, a considerable proportion declines treatment, stops taking prescribed medications, or fails to adhere to self-care guidelines.5–8 Such lack of adherence to optimum treatment strategies results in increased hospitalizations and morbidity, wastage of costly medications, and even premature deaths.9
Data suggest that clinicians who develop a good relationship of regular contact with their patients and involve patients in their treatment decisions are more successful in achieving patient compliance with pharmacological strategies and thus improved outcomes.10,11 In addition, widespread dissemination of clinical trial data and international evidence-based treatment guidelines may improve prescribing patterns and ensure that patients receive high-quality care. Indeed, with the rising incidence of CHF and concerns over the undertreatment of many CHF patients, there is an urgent need to ensure that formalized, evidence-based treatment guidelines for CHF management are widely available to clinicians.
The European Society of Cardiology (ESC) Guidelines for the Diagnosis and Treatment of Chronic Heart Failure have recently been revised to provide clinicians with updated guidance in CHF diagnosis and management based on the data from recent large-scale, randomized, placebo-controlled trials.12 Effective dissemination of the revised guidelines and rapid uptake into routine clinical practice are of paramount importance, if survival rates among CHF patients are to be improved.
The following articles describe the epidemiology and burden of CHF and discuss effective pharmacological strategies for its management with reference to recent trial data and the ESC Guidelines. A particular focus is given to angiotensin II type 1 receptor blockers, which have been used in HF management with caution but are given a stronger recommendation in the revised guidelines following the publication of data from a number of recent large-scale clinical trials. Strategies for achieving successful adoption of the guidelines in clinical practice and improving patient compliance are also discussed.
This work was supported by an unrestricted educational grant from Takeda Pharmaceutical Company Limited.
Conflict of interest: none declared.
References
- Croft JB, Giles WH, Pollard RA et al. Heart failure survival among older adults in the United States: a poor prognosis for an emerging epidemic in the Medicare population. Arch Intern Med 1999;159:505–510.
[Abstract/Free Full Text] - Dargie HJ, McMurray JJ. Diagnosis and management of heart failure. BMJ 1994;308:321–328.
[Abstract/Free Full Text] - Stewart S, MacIntyre K, Hole DJ et al. More ‘malignant’ than cancer? Five-year survival following a first admission for heart failure. Eur J Heart Fail 2001;3:315–322.[CrossRef][ISI][Medline]
- Gibbs LM, Addington-Hall J, Gibbs JS. Dying from heart failure: lessons from palliative care. Many patients would benefit from palliative care at the end of their lives. BMJ 1998;317:961–962.
[Free Full Text] - Cleland JG, Cohen-Solal A, Aguilar JC et al. Management of heart failure in primary care (the IMPROVEMENT of Heart Failure Programme): an international survey. Lancet 2002;360:1631–1639.[CrossRef][ISI][Medline]
- Horowitz CR, Rein SB, Leventhal H. A story of maladies, misconceptions and mishaps: effective management of heart failure. Soc Sci Med 2004;58:631–643.
- Higashi T, Shekelle PG, Solomon DH et al. The quality of pharmacologic care for vulnerable older patients. Ann Intern Med 2004;140:714–720.
[Abstract/Free Full Text] - Eagle KA, Kline-Rogers E, Goodman SG et al. Adherence to evidence-based therapies after discharge for acute coronary syndromes: an ongoing prospective, observational study. Am J Med 2004;117:73–81.[CrossRef][ISI][Medline]
- Haynes RB, McDonald H, Garg AX et al. Interventions for helping patients to follow prescriptions for medications. The Cochrane Database of Systematic Reviews [2], Art. no.: CD000011. 2002. [Electronic Citation].
- Royal Pharmaceutical Society of Great Britain. From compliance to concordance: towards shared goals in medicine taking. (Report). 1997. London: Royal Pharmaceutical Society of Great Britain.
- Stewart S, Horowitz JD. Home-based intervention in congestive heart failure: long-term implications on readmission and survival. Circulation 2002;105:2861–2866.
[Abstract/Free Full Text] - Swedberg K, The Task Force for the Diagnosis and Treatment of Chronic Heart Failure of the European Society of Cardiology. Guidelines for the diagnosis and treatment of chronic heart failure. Eur Heart J 2005;26:1115–1140.
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