[Epidemiologic aspects of heart failure: incidence, causes and follow-up]

Congestive heart failure can develop as a complication of virtually all forms of heart diseases. Depending on diagnostic criteria, the figures for prevalence and incidence differ markedly. The frequency of congestive heart failure increases with age and doubles in each life decade. In the United States the prevalence of 1% and for Great Britain 0.4% respectively have been calculated. In the highest age groups up to 90 new cases/1000 population per year can be observed. As a contribution to decreasing mortality of acute myocardial infarction and better treatment of high blood pressure as well as congestive heart failure the number of patients in heart failure have increased substantially. In contrast to the Framingham Study, nowadays coronary artery disease is the most prevalent etiology of congestive heart failure followed by hypertensive heart disease. In younger patient groups with advanced heart failure, like heart transplant recipients, cardiomyopathies are the main etiologic factor. Heart failure is the leading factor for emergency admissions to hospital in adult internal medicine. The main reasons for decompensation are acute ischemic syndromes for acute congestive heart failure and compliance problems for chronic congestive heart failure. The natural history of congestive heart failure is characterized by a marked progression, increasing with the severity of heart failure. In parallel, mortality increases, too. A variety of clinical, hemodynamic neurohumoral and electrophysiologic factors have been described as independent factors predicting prognosis. 30 to 50% of heart failure patients die a sudden death as compared with progressive pump failure or infectious complications in the others.