Heart failure: the cardiovascular epidemic of the 21st century

Heart failure, be it with preserved or reduced left ventricular function, is the cardiovascular epidemic of the 21st century,1–4 and it thus appropriate to devote a whole issue of the European Heart Journal to this problem. It is of note that this is at least in part a consequence of the success of our discipline. In the 1950s when Eisenhower had his famous heart attack,5 the treating physician did not have many options; accordingly, the mortality rate averaged ∼50% for those reaching hospital. Heart attack survivors of the time were prone to developing heart failure or sudden death. Today we are much more successful in treating patients with acute myocardial infarction. Thanks to the implementation of current guidelines,6,7 the mortality rate today is ∼5% for those getting to hospital and receiving appropriate treatment in a hospital with the capability to perform primary percutaneous coronary intervention.8 Another reason for the increase in heart failure hospitalizations is the prevention of sudden death in patients with impaired left ventricular function by the use of devices and antiarrhythmic drugs.9,10 Finally, the introduction of drugs and interventions for the treatment of high blood pressure11,12 has reduced the occurrence of stroke and myocardial infarction, but has led to an increase in heart failure with preserved and reduced ejection fraction.3,4 In this issue, several major developments in the treatment of heart failure at large, as well as in the field of cardiac synchronization therapy, novel drugs interfering with several neurohumoral mediators, catheter-based valvular interventions, and novel developments such as vagal stimulation are discussed. The first paper, a FAST TRACK manuscript entitled ‘ Chronic vagal stimulation for the treatment of low ejection fraction heart failure: results of the NEural Cardiac TherApy foR …