[Chronic heart failure: structural and functional deficit of our health policy?].
The problems concerning chronic heart failure can be summarized in 4 paradoxes which concern epidemiology, diagnosis, therapy, and financing respectively. Paradox I: The mortality due to chronic heart failure continues to increase worldwide despite a slow but significant decrease in mortality due to acute coronary syndromes. Paradox II: The clinical manifestations of chronic heart failure correlate poorly with the underlying pathophysiological progression. Paradox III: There is a striking discordance between the perception of evidence-based guidelines by the primary care physician and the actual reality in his/her private medical practice. Paradox IV: The inevitable increase in financial cost contrasts sharply with the many desperate attempts for cost reduction by the government.


METHODS
Heart Failure Clinic. Since the introduction of the first heart failure clinics in Sweden in 1990, numerous studies in various countries have emphasized the medical-cardiological and economical benefit of such organizations, mainly as a result of a substantial reduction of more than 40% in hospitalization. Moreover, a more central role is attributed to the primary care general practicioner.
Brutsaert
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DL
D001530:Belgium; D002303:Cardiac Output, Low / Q000188:drug therapy / Q000191:economics / Q000401:mortality; D003362:Cost-Benefit Analysis; D019317:Evidence-Based Medicine; D006291:Health Policy / Q000191:economics / Q000639:trends; D006760:Hospitalization / Q000191:economics / Q000706:statistics & numerical data*; D006801:Humans; D009026:Mortality / Q000639:trends; D010818:Practice Patterns, Physicians'; D013038:Specialization