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(Circulation. 2007;116:1526-1529.)
© 2007 American Heart Association, Inc.

Editorial

Can We Predict and Prevent the Onset of Acute Decompensated Heart Failure?

Eugene E. Wolfel, MD

From the Division of Cardiology, University of Colorado at Denver and Health Sciences Center, Denver.

Correspondence to Eugene E. Wolfel, MD, Department of Medicine, Division of Cardiology, University of Colorado at Denver and Health Sciences Center, Academic Office 1, Room L15-7017, 12631 E 17th Ave, PO Box 6511, Aurora, CO 80045. E-mail gene.wolfel@uchsc.edu

Key Words: Editorials • diagnosis • heart failure

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Watch the disease in time: For when, within the dropsy rages, and extends the skin, in vain for helebore the patient cries, and sees the doctor, but too late is wise: Too late for cure, he proffers half his wealth; ten thousand doctors cannot give him health.

— —Benjamin Franklin, Poor Richard’s Almanack, 1749

This rather pessimistic representation of heart failure (dropsy) in the 18th century has some relevance to the presentation of acute decompensation in patients with chronic heart failure in our current century, despite the availability of various therapies that prolong survival and decrease the morbidity of this disorder. In 2006, >1 million hospitalizations for acute decompensated heart failure (ADHF) occurred, and the number of heart failure hospitalizations have increased 175% since 1979.¹ The vast majority of these patients, 75.6%, had a history of heart failure,² and the in-hospital mortality was 3.2%. Patients with preserved left ventricular (LV) systolic function have a slightly lower in-hospital mortality (2.9%) compared with those with an LV ejection fraction 40% (3.9%); however, the 3-month mortalities were similar at 9.5% to 9.8%.³ Rehospitalization rates remain high at 29% to 30% for patients with both preserved and decreased LV systolic function, and rehospitalization is an independent predictor of 1-year mortality, especially in elderly patients.⁴ In addition, patients with ADHF are at greater risk for death and morbidity than those with stable chronic heart failure.⁵ Thus, the natural history of heart failure may be altered by repeated episodes of decompensation requiring hospitalization. Finally, a tremendous . . . [Full Text of this Article]

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