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Epidemiology and general pathophysiological classification of heart failure 

Epidemiology and general pathophysiological classification of heart failure
Epidemiology and general pathophysiological classification of heart failure

Theresa A McDonagh

and Kaushik Guha


This chapter and the others in this section are expansions of the conversation that was previously contained in chapter 16.5.1: Clinical features and medical treatments. Older versions of all of the content in this section can be seen in the version history of this chapter.

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date: 27 September 2021

Definition and classification—heart failure is a clinical syndrome caused by cardiac dysfunction, most commonly left ventricular systolic dysfunction (LVSD). Many epidemiological studies focus on characterizing the incidence and/or prevalence of LVSD, using cut off points ranging from less than 30% to less than 50%. Patients with heart failure symptoms or signs and normal or near normal LV function are often classified as having heart failure with preserved ejection fraction (HF-PEF), but there is no clear and generally accepted definition of this condition. Epidemiology—estimates of incidence and prevalence are heavily influenced by definition. An echocardiographic study of a random sample of the general population aged 25–74 years in Glasgow (Scotland) estimated a prevalence of heart failure of 1.5%, with a further 1.4% having asymptomatic LVSD. Prevalence rises significantly with age, with a median age of first presentation in the mid seventies. Longitudinal data suggests that the incidence of heart failure has remained fairly stable over the last few decades, but prevalence is increasing as more people survive cardiovascular disease earlier in life. Aetiology—determining the aetiology of heart failure in epidemiological studies is difficult: the commonest cause in the developed world is coronary artery disease, followed by hypertension, which predominates in those with a diagnosis of HF-PEF. Prognosis and morbidity—data from the United States of America and the United Kingdom show the death rates of those admitted to hospital with a diagnosis of heart failure have a mortality of over 30% at one year. The outcome has improved in recent years, perhaps linked to the increased usage of angiotensin inhibitors and β‎-blockers. Heart failure accounts for around 5% of all adult general medical admissions, and in developed countries the condition consumes 1 to 2% of health care budgets.

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