to the (recurrent) hospitalizations of these patients for
decompensating heart failure.
The most important cause of heart failure is chronic coronary
artery disease. Gheorghiade and Bonow (2) pooled
data from 13 randomized, multicenter heart failure drug
trials (involving over 20,000 patients) reported in The New
England Journal of Medicine between 1986 and 1997. The
authors concluded that coronary artery disease was the underlying
etiology in almost 70% of the patients. The actual
figure may have been even higher because many patients in
these trials did not undergo coronary angiography.
The long-term prognosis for patients with heart failure
remains poor, despite advances in different therapies. Recent
data from the Framingham Heart Study demonstrated
5-y mortality rates of 59% for men and 45% for women
with heart failure in the period from 1990 through 1999 (3).
Mortality rates are particularly high in older people with
heart failure.