Authors: Mark Huffman, Gregory Roth, Karen Sliwa, Clyde Yancy, Dorairaj Prabhakaran
Data is presented on the efficacy, effectiveness, and cost-effectiveness of priority heart failure-related interventions. Heart failure, a clinical syndrome in which the heart proves unable to meet the metabolic demands of the body because of functional limitations in ventricular filling (diastole), ejection (systole), or both, remains a heterogeneous, progressive, chronic disease with protean symptoms, including fatigue; breathlessness at rest or with exertion; and fluid retention in the lungs, abdomen, or extremities. The predominant underlying causes of heart failure vary substantially by region. Several inexpensive therapies can improve the natural history of heart failure, particularly in the presence of left-ventricular systolic dysfunction. While the prevention of heart failure remains ideal, a resource-stratified approach to integrate and adopt interventions, including coprimary strategies to diagnose patients early in the disease course and to improve initiation and adherence to medication regimens, remains viable. Updated local and regional health policy and cost-effectiveness models may prove useful methods for evaluating the effect of health system arrangements for acute and chronic treatment on outcomes and costs.