Preface

Medical students in the 1980s and earlier were taught that heart failure was characterised by a miserable prognosis and that there was very little that could be done for patients beyond giving diuretics and preparing for an unavoidably short prognosis. Trainees contemplating a career as an academic cardiologist were warned to avoid the field of heart failure as recently as 1990, as everything was known and the prognosis was still bleak: surely the field of interventional cardiology was a better one to pursue?

We all know now how things have progressed: perhaps more than any other field in cardiology (and, indeed, medicine), the management of patients with heart failure has dramatically changed, fuelled by the quality of evidence-based medicine provided by large randomised controlled treatment trials. Although little perhaps has advanced in acute heart failure, chronic heart failure has become just that: a chronic condition rather than an inevitable death sentence. Those of us who manage patients with chronic heart failure practise with the certainty of a large evidence-base informing much of what we do, from arriving at the original diagnosis, through medical and device therapy, to general strategies of care. We know that what we do approximately doubles life-expectancy for patients.

Heart failure is a condition touching the lives of many, from basic scientists, to physicians in emergency rooms, to nurses running home care services. The requirements for a good heart failure service range from the relatively inexpensive use of pharmacological agents through well-structured diagnostic, treatment, and monitoring programmes, to expensive interventions such as implantable cardioverter-defibrillators, left ventricular assist devices, and even transplantation.

We hope that this book will have something to offer all those managing the range of patients with heart failure. A particular concern has been to offer chapters on the comorbidities patients suffer: most patients in clinical trials are a decade or so younger and have far fewer comorbidites than patients with heart failure in the typical clinic. We have tried to cover the whole spectrum of management through the whole clinical course of heart failure, and hope in so doing that this is a book that many will find useful as a reference point, but also as a practical guide in how to manage our patients.