[Management of heart failure: ambition and reality in the early 21st Century]

At the beginning of the 21st century, we are faced with a discrepancy between the favourable results produced by a series of large randomised controlled trials on heart failure and their poor implementation into clinical practice. (ACE-inhibition, beta-blockade, aldosterone antagonism). The organisation of care for patients with heart failure needs improvement. This is why the first large international survey was initiated to evaluate perception and practice of primary care physicians (PCPs) in the management of heart failure. In general, PCPs appeared well-informed about diagnostic steps and therapeutic interventions. In practice, most patients received appropriate diagnostic tests. The uptake of ACE inhibitors was high, but few patients were receiving recommended doses. Beta-blockers are currently underused but this situation may be changing rapidly. Though "IMPROVEMENT" might suggest we get it right fairly often, it does also indicate that the process is haphazard and that we could be much more efficient.