ABC of heart failure: History and epidemiology

Heart failure is the end stage of all diseases of the heart and is a major cause of morbidity and mortality. It is estimated to account for about 5% of admissions to hospital medical wards, with over 100 000 annual admissions in the United Kingdom. “The very essence of cardiovascular practice is the early detection of heart failure” Sir Thomas Lewis, 1933 #### Some definitions of heart failure “A condition in which the heart fails to discharge its contents adequately” (Thomas Lewis, 1933) “A state in which the heart fails to maintain an adequate circulation for the needs of the body despite a satisfactory filling pressure” (Paul Wood, 1950) “A pathophysiological state in which an abnormality of cardiac function is responsible for the failure of the heart to pump blood at a rate commensurate with the requirements of the metabolising tissues” (E Braunwald, 1980) “Heart failure is the state of any heart disease in which, despite adequate ventricular filling, the heart's output is decreased or in which the heart is unable to pump blood at a rate adequate for satisfying the requirements of the tissues with function parameters remaining within normal limits” (H Denolin, H Kuhn, H P Krayenbuehl, F Loogen, A Reale, 1983) “A clinical syndrome caused by an abnormality of the heart and recognised by a characteristic pattern of haemodynamic, renal, neural and hormonal responses” (Philip Poole-Wilson, 1985) “A syndrome … which arises when the heart is chronically unable to maintain an appropriate blood pressure without support” (Peter Harris, 1987) “A syndrome in which cardiac dysfunction is associated with reduced exercise tolerance, a high incidence of ventricular arrhythmias and shortened life expectancy” (Jay Cohn, 1988) “Abnormal function of the heart causing a limitation of exercise capacity” or “ventricular dysfunction with symptoms” (anonymous and pragmatic) “Symptoms of heart failure, objective evidence of cardiac dysfunction and …