The Emerging Epidemic of Heart Failure

• Americans are developing chronic heart failure (CHF) in ever increasing numbers as medical and surgical treatment of other cardiovascular diseases improves. CHF now affects nearly five million Americans, and over 500,000 new cases are reported every year. With the ageing of the American population and continuing improvement in the treatment of cardiovascular diseases, the epidemic is expected to continue.

• The risk factors for CHF are largely the same as those for coronary artery disease (CAD) and heart attack. Clinical trials have demonstrated that many of the same drugs used to reduce or eliminate common risk factors are also effective in reducing hospitalization and mortality due to CHF. Currently, standard quadruple therapy for symptomatic CHF includes an angiotensin converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB), a β-blocker, a diuretic, and digoxin. A fifth drug, an aldosterone antagonist, is also recommended.

• Market drivers for the development of medical therapy for CHF are currently focused on severely ill patients. New drugs for the treatment of decompensated CHF have been developed and approved, and others are in the pipeline. Where medical therapy has failed, new surgical approaches have proven very useful as a bridge to heart transplantation. As the fundamental biochemical processes that produce detrimental changes in the heart's structure (remodeling), are better understood, innovative new drugs that target these processes are likely to be developed.

• Incidence and prevalence data were obtained from the American Heart Association and the National Heart, Lung, and Blood Institute. U.S. population estimates were obtained from the U.S. Census Bureau.