ABSTRACT
Heart failure is the only common cardiovascular disease in the United States that has a
rising incidence and prevalence (Fig. 1) (1-3). The latest statistics from the American Heart
Association estimate that approximately 4.9 million Americans have this disorder (1). The
current incidence of disease is estimated to exceed 400,000 new symptomatic cases per
year, directly accounting for over 250,000 deaths annually (Fig. 2) (1,4). Between 1.5% and
2% of the U.S. population has symptomatic heart failure and its prevalence is estimated to
be 6%–10% over the age of 65 yr (5). Using the Framingham Heart Study cohort, Lloyd-
Jones et al. determined the life-time risk of developing heart failure for men and women
free of overt disease at age 40 yr to approximate 20% (Fig. 3) (6). There is a marked age-
dependence in heart failure incidence and prevalence with elderly patients being
disproportionately affected by the disease (Fig. 4) (7-9). The increased ability to identify
asymptomatic left ventricular dysfunction and its progressive nature recently led to a
“redefinition” of heart failure by the American College of Cardiology/American Heart
Association consensus guidelines (4). The new ACC/AHA re-classification emphasizes the
large number of “at risk” patients and encourages physicians to implement treatment
strategies similar to those utilized for asymptomatic patients with risk factors for coronary
artery disease. Patients in stage A (high risk for heart failure but without structural heart
disease) and stage B (structural heart disease without overt heart failure symptoms) are an
increasingly important focus for identification and treatment (Fig. 5). A variety of studies
have demonstrated that the prevalence of asymptomatic left ventricular dysfunction in the
community setting ranges from 1% to 2.4% (Table 1) (10-11).
