The less familiar face of heart failure.

Nearly five million Americans have heart failure (HF) today, an incidence approaching 10 per 1,000 population after the age of 65 years. Heart failure is the reason for at least 20% of all hospital admissions in persons above the age of 65 years; hospitalizations for HF have increased by 159% (1). Substantial efforts have been made to identify and treat those factors that predict recurrent hospitalization for HF, in addition to the identification of therapies that improve overall survival. Indeed, over the past decade, multiple clinical trials have unequivocally demonstrated a significant reduction in mortality for patients with systolic HF. Simultaneously, however, large epidemiologic or cohort registries have not observed an equivalent impact on overall death rates from HF (2–4). Clearly, as has been noted by a number of investigators, the patients entered into recent clinical trials of HF have not been entirely representative of the “typical” patient with HF in the U.S. (5).