Expert Commentary

Best Practices in Treatment of Heart Failure

Clyde W. Yancy, MD, FACC, FAHA, MACP

Medical Director
Baylor Heart and Vascular Institute
Baylor University Medical Center
Dallas, Texas

Heart failure is a progressive disease which develops over many years and is one of the leading causes of morbidity and mortality in the U.S., with increasing importance as the population ages. Notably, it is the single most common reason for hospital admissions for patients over 65 years old.1 Manifestations in its early stages vary widely, and do not necessarily entail loss of systolic pump function.2 Indeed, a substantial proportion of patients have symptoms of heart failure despite normal ejection fraction. Basic and clinical research has led to a robust understanding of disease mechanisms, as well as a plethora of evidence-based interventions to treat and/or slow progression. However, clinical evidence also suggests that a much greater public health impact can be achieved by applying well-established strategies for reducing the heart failure risk posed by hypertension, dyslipidemia, hyperglycemia, obesity and excessive sodium intake.3 Implementation of these strategies offers the best opportunity to intervene even before the onset of left ventricular dysfunction or major symptoms of heart failure, and substantially reduce its long-term consequences.
 

References

  1. Roger VL. The heart failure epidemic. Int J Environ Res Public Health. 2010;7:1807-1830.
  2. Hunt SA, Abraham WT, Chin MH, et al. 2009 focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines: developed in collaboration with the International Society for Heart and Lung Transplantation. Circulation. 2009;119:e391-479.
  3. Yancy CW. The prevention of heart failure in minority communities and discrepancies in health care delivery systems. Med Clin North Am. 2004;88:1347-1368, xii-xiii.
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