Editorial The Life Cycle of the Heart Failure Patient

Heart failure (HF) is an epidemic with an estimated 23 million people afflicted worldwide. In the US, there are 5.1 million people ≥ 20 years of age with heart failure and 875,000 new patients being diagnosed each year [1]. Projections show that by 2030, the prevalence of HF will increase by 23% overall from current 2013 estimates with 26% of patients over the age of 80 years [2]. At 40 years of age, the lifetime risk of developing HF for both men and women is 1 in 5. Hospitalization due to heart failure as a primary diagnosis is reported in over 1 million patients yearly as a first diagnosis with an additional 3 million hospitalizations as a contributing diagnosis. There were 676,000 ED visits for heart failure and 1.8 million outpatient visits in 2010. Although prognosis has improved, the 5-yr mortality rate remains at 50%. Medicare patients have a 30% 1-year mortality rate after HF hospitalization. Heart failure is now the 2 nd most common diagnosis for entering hospice. Heart failure was recorded in 1 of every 9 death certificates in 2009. The annual US healthcare cost is enormous, estimated to be 30.7 billion dollars in 2012 [1]. By 2030, the cost of HF care will almost triple for those over the age of 65 yrs. In 2001, the AHA/ACC Heart Failure Guideline introduced the concept of heart failure stages which was expanded in the 2013 American Heart Association/American College of Cardiology HF Guideline (Fig. 1) [3, 4]. Stage A represents the patients at high risk for the development of HF. It is critical to identify and aggressively treat Stage A patients to prevent progression to structural heart disease and heart failure. Stage B comprises the patients who have known structural heart disease but who do not yet have symptoms (NYHA class I). Treating these patients will prevent further cardiac remodeling and development of symptomatic HF. Stage C includes both patients with HF and reduced ejection fraction (HFrEF) and those with HF and preserved ejection (HFpEF). Stage C patients have mild to moderate symptoms (NYHA class II-more than ordinary activity produces symptoms and NYHA class III-less than ordinary activity produces symptoms of fatigue, dyspnea). Stage D represents refractory patients – NYHA class IV who experience symptoms at rest or with minimal activity and have recurrent hospitalizations despite receiving guideline-directed therapy. These patients are candidates for assist devices, cardiac transplant, or …