Improving Outcomes in Heart Failure

eart failure is approaching epidemic proportions worldwide and is associated with substantial public and personal burden.[1][2][3] The public burden of heart failure is evident in the enormous costs of caring for patients with heart failure.4 Indeed, heart failure is the largest single Medicare expenditure and is the leading cause of hospitalization for those Ͼ65 years of age in many industrialized countries, including the United States.The majority of these healthcare costs can be attributed to hospitalizations for exacerbation of congestive heart failure.4 The 6-month readmission rate for congestive heart failure is close to 50%.[5][6] The personal burden of heart failure includes debilitating symptoms, frequent rehospitalizations, and high rates of mortality.Five years after receiving a diagnosis of heart failure, Ͻ40% of men or women are still alive.[7][8] Thus, the report in this issue of Circulation by Stewart and colleagues 9 that patients randomized to a home-based heart failure disease management intervention instead of usual care had 36% fewer rehospitalizations and a 28% reduction in risk of death from all causes is of more than casual interest to patients, healthcare providers, and the institutions that provide health care for these patients.Before we discuss the significance and potential impact of the findings by Stewart et al, 9 however, it will be useful to digress and briefly review the existing literature about the types of heart failure disease management programs that have proved useful thus far.