A Look Back at "The Management of Heart Failure 5 Years Hence"

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Abstract

It is interesting to look back at our predictions1 to see where we are relative to these forecasts. Five years is not that long ago and so, hopefully, we will be close to the targets we set.

Citation
Am Heart Hosp J. 2011;9(2):78-80

Pages

It is interesting to look back at our predictions1 to see where we are relative to these forecasts. Five years is not that long ago and so, hopefully, we will be close to the targets we set.

Prevention

Prevention remains the ultimate approach to managing heart failure (HF). Basically, we are talking about eliminating the risks for left ventricle (LV) dysfunction for the Stage A patient (who has risks for LV dysfunction, but with a normal LV) and eliminating the threatening risks for the Stage B patient (who has asymptomatic LV dysfunction) with the intent of preventing, or at least delaying, the progression of LV dysfunction into symptomatic HF. Unfortunately, our preventive interventions are still blunted by social and economic roadblocks.
More physicians are aware of these risks, but how are we doing? Hypertension awareness in the general public has risen and the need to bring hypertension under control has caught the attention of more practicing physicians. The target blood pressure remains a moving target, but certainly <140 mmHg systolic is a good place to start. Patient compliance, largely related to the cost and convenience of delivering the ideal antihypertensive therapy, is a limiting factor for millions.
The risk of high blood lipids has also attracted public awareness and the attention of practicing physicians. Again, patient adherence to lipid management is often the limiting factor, not only in taking the one or more medications, but also in obtaining the follow-up lipids, liver enzymes, and related studies. Having physicians test for lipids in their adult and adolescent populations is a good start.
Inpatient diabetic control has lightened up somewhat (from strict diabetic management) and outpatient management has benefited from the introduction of new improved agents to provide a wider spectrum of choices and overall better control.
There are data to show that tobacco abuse is slowly dropping, but remains a major threat among many of our young (who will most probably drag smoking into adulthood). Other forms of substance abuse (e.g. alcohol and drugs) remain unchanged in prevalence or, in some circles, slowly growing in popularity.

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References
  1. Leier CV, Haas GJ, The management of heart failure 5 years hence, Am Heart Hospital J, 2006;4:207–10.