Elsevier

The Lancet

Volume 362, Issue 9378, 12 July 2003, Pages 147-158
The Lancet

Review
Demographics and concomitant disorders in heart failure

https://doi.org/10.1016/S0140-6736(03)13869-XGet rights and content

Summary

Chronic heart failure is an increasingly common cause of premature death and poor quality of life. Community-based epidemiological studies have provided much-needed information on the demography of chronic heart failure, providing insight into its influence on public health. In most patients, chronic heart failure is accompanied by a range of concomitant disorders that both contribute to the cause of the disease and have a key role in its progression and response to treatment. Information on the most common comorbidities in chronic heart failure-ischaemic heart disease, hypertension, and diabetes mellitus-is presented for prespecified subgroups in the reports of many large-scale, multicentre trials; despite their limitations, these subanalyses provide guidance in therapeutic decision-making. Similarly, because chronic heart failure is commonly an endpoint in intervention trials of both hypertension and diabetes, such studies afford important information on the prevention of chronic heart failure in these common diseases.

Section snippets

Demography

The demographic characteristics of patients with chronic heart failure have mostly been obtained from community-based epidemiological studies and large, multicentre intervention trials.2 However, compared with participants of intervention trials, populations in community-based studies are generally older, less predominantly male, more likely to have comorbidities, and presentation with diastolic failure is common3 (Table 1, Table 2).4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20,

Concomitant disorders

Many patients with chronic heart failure have a range of comorbidities that both contribute to the cause of the disease and have a key role in its progression and response to therapy.

Respiratory disorders

The interaction between chronic heart failure and concomitant respiratory disease is important. Many patients with heart failure are misdiagnosed as having airflow obstruction on the basis of overlapping symptoms (and vice versa). Optimum assessment and management of these patients needs careful consideration of the possibility that cardiac and respiratory disease may coexist in the individual patient.

β blockers are deemed to be contraindicated in patients with chronic heart failure and airflow

Conclusions

Chronic heart failure is a complex disease with progression and response to therapy influenced by various important demographic factors and comorbid disorders. These factors also have substantial influence on therapeutic decision-making for this disorder.

Search strategy and selection criteria

The search strategy for this review was based on published epidemiological studies and trials in heart failure involving more than 1000 patients during the past 10 years, from which baseline data on demography and comorbidity could be derived. These sources were supplemented by relevant further papers that provided epidemiological, mechanistic, or therapeutic information within comorbid disorders judged of greatest importance to patients with heart failure.

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