The Treatment Of Heart Failure

During recent decades, heart failure has become one of, if not the, most important syndrome(s) in the cardiovascular area in terms of prevalence, morbidity, healthcare costs and mortality. Although heart failure treatment has developed rapidly and several novel approaches aimed at preventing or retarding worsening of failure are available in addition to those providing symptomatic relief, many patients are still treated inappropriately. This is particularly true for angiotensin-converting enzyme (ACE) inhibition, which, despite the fact that only slightly more than 50% of heart failure patients receive this form of therapy, should be given to all patients with the syndrome, irrespective of the severity. Heart failure patients are under the care of different types of doctors, including general practitioners (estimated 80-85%) and internists and geriatricians (10-15%); cardiologists see relatively few patients. Pertinent studies in heart failure have, however, been performed by the latter group and, in general, awareness of the clinical usefulness and prescription of ACE inhibitors is therefore highest amongst these specialists. As the management of heart failure is transmural in nature, proper education of the different echelons is mandatory. Guidelines on the diagnosis and treatment of heart failure are pivotal in this process. However, it is not an easy task to prepare guidelines that are applicable in all circumstances and can be used by any kind of doctor involved in heart failure care. It is even more difficult to ensure the guidelines are implemented and it requires the input of both individual doctors and the national and international medical associations. The European Society of Cardiology is dedicated to this educational process and, through its Educational and Training Programme Committee and relevant Working Groups such as the Working Group on Heart Failure, has already set programmes into motion.