Heart failure and sudden death

The syndrome of congestive heart failure is a clinical manifestation of many cardiac disease processes when cardiovascular compensatory mechanisms are no longer able to maintain homeostasis. Approximately five million people in the United States have heart failure and over 550,000 patients are diagnosed with heart failure for the first time each year.1 The Framingham heart study reported 62% and 42% 5-year survival rates, respectively, for men and women with newly diagnosed congestive heart failure in the early 1970s.2 These mortality rates were six to seven times higher than that of the age-matched general population. Of the total mortality, approximately 40-50% were sudden deaths.3 Trends in the incidence and survival with heart failure among 11,311 subjects in the Framingham heart study during a 50 year interval have been updated.4 Heart failure occurred in 1075 study participants between 1950 and 1999. The 5-year mortality rate among men declined from 70% in the period from 1950 through 1969 to 59% in the period from 1990 through 1999, whereas the respective rates among woman declined from 57% to 45% (Figure 58-1). Although the relative decline in mortality is encouraging, likely a result of a better understanding of the disease pathophysiology and improvements in medical and device therapy, the growing epidemic of heart failure has been increasingly recognized in the United States and around the globe.