Defining heart failure

The definition of heart failure is hampered by the wide variability of the clinical symptoms and signs, and of their etiologies. Many attempts have been made to come up with a general set of criteria that describe heart failure 1–7. These criteria include clinical, epidemiological, pathophysiological, and exercise-related criteria and criteria derived from the patient's response to therapy. The need for a more circumscript definition reflects the hope to be able to stratify patient groups, to detect heart failure at an earlier stage and to optimally treat patients. At the basis of this need is our wish to understand heart failure as a pathogenetic entity. Moreover, to attain this purpose a clear definition is required for the design of adequate experimental protocols. From medical history we know that the understanding of diseases often has started with the recognition of consistency in a set of symptoms and signs. The starting point for our knowledge therefore is the definition of such a set of characteristics. Here, pathophysiological and medical objectives may, however, lead to conflicts: those searching for a pathophysiologic entity may produce a common denominator of the characteristics, whereas those concerned with the optimal treatment of their patients may come up with a description that covers all possible appearances of the phenomenon. Debates between followers of the standpoint of comprehensiveness and those of brevity continue 4–7. In order to uncover the dilemmas in the definition of heart failure, the editors of Cardiovascular Research have recently performed a survey amongst the Journal's reviewers. A letter was sent to 2238 active reviewers with a request for confirmation of data stored in the Journal's database. In the same letter the reviewers were asked to give a definition of heart failure in less than 150 words. In the 2 months following the mailing … *Corresponding author. Tel.: +31-20-566-3267; fax: +31-20-697-5458 r. coronelatamc. nl