ABSTRACT
There are 4-5 million people living with chronic heart failure and an additional 400,000
newly diagnosed yearly (1-3). The incidence of heart failure is 10 per 1000 for individuals
that are over 65 yr of age. The increasing incidence of heart failure is due primarily to the
advancing age of the population with coronary artery disease, which is now the principal
cause of heart failure associated with reduced ventricular function (dilated cardiomyo-
pathy, DCM) (4). Mortality due to progressive heart failure associated with DCM has
declined. In the Framingham study total mortality was 24% and 55% within 4 yr of
developing symptomatic heart failure for women and men, respectively (4). These
statistics approximate well the natural history of heart failure as the subject population was
untreated by contemporary standards. Recognition of the beneficial effects of ACE
inhibitors, diuretics, digoxin and beta-blockade has yielded substantial reductions in
mortality due to progressive pump failure. However, despite these improvements in
medical therapy, symptomatic heart failure still confers a 20-25% risk of premature death
in the first 21⁄2 yr after diagnosis.
