Urgent need to reorganize heart failure management: from paradoxes to heart failure clinics.
Despite the decreasing incidence of ischaemic heart disease and despite major medical advances in heart failure, the prevalence and mortality of chronic heart failure in the population is rising and the prognosis remains grim. Chronic heart failure is a complex disease, which is characterized by its progressive nature. In this paper, we approach the complexity of heart failure from four paradoxes: epidemiology, diagnosis, therapy and economical impact respectively. Taking these paradoxes into account, we formulate a number of essential components of alternative heart failure management programmes. Combating chronic heart failure requires the organization of centres for continuous care--as opposed to the traditional crisis intervention centres--preferably with a multidisciplinary structure to provide a "holistic approach" adapted to each patient's unique set of medical, psychosocial, physical and financial conditions. Patients taken care of in these novel multidisciplinary heart failure clinics have shown improved clinical status, decreased hospitalization rates, increased quality of life, longer life and lower costs.
De Keulenaer
Gilles W
GW
Center for Heart Failure and Cardiac Rehabilitation, Department of Cardiology, AZ Middelheim, University of Antwerp, Antwerp, Belgium. gilles.dekeulenaer@ua.ac.be
Brutsaert
Dirk L
DL
D002908:Chronic Disease; D003266:Continuity of Patient Care; D018450:Disease Progression; D006333:Heart Failure / Q000175:diagnosis / Q000453:epidemiology / Q000628:therapy*; D006760:Hospitalization; D006801:Humans; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011379:Prognosis; D011788:Quality of Life