Underutilization of Evidence-Based Therapy in Heart Failure:  An Opportunity to Deal a Winning Hand With Ace up Your Sleeve

Prakash C. Deedwania, MD
Arch Intern Med. 1997;157(21):2409-2412. doi:10.1001/archinte.1997.00440420029004.
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CONGESTIVE HEART failure (CHF) is a major public health problem that is increasing in prevalence. Although during the last 2 decades there has been significant decline in most cardiovascular disorders, the incidence of heart failure is actually increasing. It is estimated that nearly 5 million Americans suffer from CHF and each year approximately 400 000 new cases of heart failure are added to this pool.1,2 And it is likely that, with improved therapy for acute myocardial infarction and the aging US population, the incidence of CHF will continue to increase. The incidence of CHF approaches 10 per 1000 population after 65 years of age.2

Heart failure is a devastating illness that is associated with adverse clinical outcome and significant increase in mortality. The grave prognosis and seriousness of the problem is best illustrated by the extremely poor survival, with up to 50% 5-year mortality in patients with advanced


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