title: Contemporary strategies in the diagnosis and management of heart failure.
abstract: Heart failure (HF) is an important public health problem, and strategies are needed to improve outcomes and decrease health care resource utilization and costs. Its prevalence has increased as the population ages, and HF continues to be associated with a high mortality rate and frequent need for hospitalization. The total cost of care for patients with HF was $30.7 billion in 2012, and it is estimated to more than double to $69.8 billion by 2030. Given this reality, there has been recent investigation into ways of identifying and preventing HF in patients at risk (stage A HF) and those with cardiac structural and functional abnormalities but no clinical HF symptoms (stage B). For patients who have symptoms of HF (stage C), there has been important research into the most effective ways to decongest patients hospitalized with acute decompensated HF and prevent future hospital readmissions. Successful strategies to treat patients with HF and preserved ejection fraction, which has increased in prevalence, continue to be sought. We are in the midst of a rapid evolution in our ability to care for patients with end-stage HF (stage D) because of the introduction of and improvements in mechanical circulatory support. Left ventricular assist devices used as destination therapy offer an important therapeutic option to patients who do not qualify for heart transplant because of advanced age or excessive comorbidity. This review provides a thorough update on contemporary strategies in the diagnosis and management of HF by stage (A to D) that have emerged during the past several years.
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN; Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN. Electronic address: Dunlay.Shannon@mayo.edu.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Dunlay
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Naveen L
authors.initials: NL
authors.lastname: Pereira
authors.affiliation: Division of Cardiovascular Diseases, Department of Internal Medicine, Mayo Clinic, Rochester, MN.
authors.forename: Sudhir S
authors.initials: SS
authors.lastname: Kushwaha
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014487:Centers for Medicare and Medicaid Services, U.S. / Q000191:economics / Q000592:standards; D015897:Comorbidity; D003363:Cost Control; D019468:Disease Management; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000453:epidemiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000191:economics / Q000592:standards* / Q000706:statistics & numerical data; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000191:economics / Q000379:methods*; D019984:Quality Indicators, Health Care; D018570:Risk Assessment / Q000379:methods; D012737:Sex Factors; D014481:United States / Q000453:epidemiology