Mayo Clinic Proceedings Home

Chronic Heart Failure: Contemporary Diagnosis and Management

      Chronic heart failure (CHF) remains the only cardiovascular disease with an increasing hospitalization burden and an ongoing drain on health care expenditures. The prevalence of CHF increases with advancing life span, with diastolic heart failure predominating in the elderly population. Primary prevention of coronary artery disease and risk factor management via aggressive blood pressure control are central in preventing new occurrences of left ventricular dysfunction. Optimal therapy for CHF involves identification and correction of potentially reversible precipitants, target-dose titration of medical therapy, and management of hospitalizations for decompensation. The etiological phenotype, absolute decrease in left ventricular ejection fraction and a widening of QRS duration on electrocardiography, is commonly used to identify patients at increased risk of progression of heart failure and sudden death who may benefit from prophylactic implantable cardioverter-defibrillator placement with or without cardiac resynchronization therapy. Patients who transition to advanced stages of disease despite optimal traditional medical and device therapy may be candidates for hemodynamically directed approaches such as a left ventricular assist device; in selected cases, listing for cardiac transplant may be warranted.
      ACC (American College of Cardiology), ACEI (angiotensin-converting enzyme inhibitor), ADHF (acute decompensated heart failure), AF (atrial fibrillation), AHA (American Heart Association), ARB (angiotensin II receptor blocker), CABG (coronary artery bypass grafting), CAD (coronary artery disease), CHF (chronic heart failure), CRT (cardiac resynchronization therapy), ICD (implantable cardioverter-defibrillator), LV (left ventricular), LVAD (LV assist device), LVEF (LV ejection fraction), MI (myocardial infarction), MR (mitral regurgitation), SCD (sudden cardiac death), UF (ultrafiltration)
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Mayo Clinic Proceedings
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      REFERENCES

        • McCullough PA
        • Philbin EF
        • Spertus JA
        • et al.
        Confirmation of a heart failure epidemic: findings from the Resource Utilization Among Congestive Heart Failure (REACH) study.
        J Am Coll Cardiol. 2002; 39: 60-69
        • Zile MR
        • Brutsaert DL
        New concepts in diastolic dysfunction and diastolic heart failure: Part I; diagnosis, prognosis, and measurements of diastolic function.
        Circulation. 2002; 105: 1387-1393
        • Lloyd-Jones DM
        • Larson MG
        • Leip EP
        • et al.
        Lifetime risk for developing congestive heart failure: the Framingham Heart Study.
        Circulation. 2002; 106: 3068-3072
        • Ghali JK
        • Kadakia S
        • Cooper RS
        • Yiao YL
        Bedside diagnosis of preserved versus impaired left ventricular systolic function in heart failure.
        Am J Cardiol. 1991; 67: 1002-1006
        • Stevenson LW
        • Perloff JK
        The limited reliability of physical signs for estimating hemodynamics in chronic heart failure.
        JAMA. 1989; 261: 884-888
        • Mckee PA
        • Castelli WP
        • McNamara PM
        • Kannel WB
        The natural history of congestive heart failure: the Framingham study.
        N Engl J Med. 1971; 285: 1441-1446
        • Maisel AS
        • Krishnaswamy P
        • Nowak RM
        • Breathing Not Properly Multinational Study Investigators
        • et al.
        Rapid measurement of B-type natriuretic peptide in the emergency diagnosis of heart failure.
        N Engl J Med. 2002; 347: 161-167
        • McCullough PA
        • Duc P
        • Omland T
        • Breathing Not Properly Multinational Study Investigators
        • et al.
        B-type natriuretic peptide and renal function in the diagnosis of heart failure: an analysis from the Breathing Not Properly Multinational Study.
        Am J Kidney Dis. 2003; 41: 571-579
        • Mehra MR
        • Uber PA
        • Park MH
        • et al.
        Obesity and suppressed B-type natriuretic peptide levels in heart failure.
        J Am Coll Cardiol. 2004; 43: 1590-1595
        • He J
        • Ogden LG
        • Bazzano LA
        • Vupputuri S
        • Loria C
        • Whelton PK
        Risk factors for congestive heart failure in US men and women: NHANES I epidemiologic follow-up study.
        Arch Intern Med. 2001; 161: 996-1002
        • Vasan RS
        • Levy D
        The role of hypertension in the pathogenesis of heart failure: a clinical mechanistic overview.
        Arch Intern Med. 1996; 156: 1789-1796
        • Levy D
        • Larson MG
        • Vasan RS
        • Kannel WB
        • Ho KK
        The progression from hypertension to congestive heart failure.
        JAMA. 1996; 275: 1557-1562
        • Moser M
        • Herbert PR
        Prevention of disease progression, left ventricular hypertrophy and congestive heart failure in hypertension treatment trials.
        J Am Coll Cardiol. 1996; 27: 1214-1218
        • Ho KK
        • Pinsky JL
        • Kannel WB
        • Levy D
        The epidemiology of heart failure: the Framingham Study.
        J Am Coll Cardiol. 1993; 22: 6A-13A
        • Walsh CR
        • Larson MG
        • Evans JC
        • et al.
        Alcohol consumption and risk for congestive heart failure in the Framingham Heart Study.
        Ann Intern Med. 2002; 136: 181-191
        • Bryson CL
        • Mukamal KJ
        • Mittleman MA
        • et al.
        The association of alcohol consumption and incident heart failure: the Cardiovascular Health Study.
        J Am Coll Cardiol. 2006; 48: 305-311
        • Gillman MW
        • Cook NR
        • Evans DA
        • et al.
        Relationship of alcohol intake with blood pressure in young adults.
        Hypertension. 1995; 25: 1106-1110
        • Kenchaiah S
        • Evans JC
        • Levy D
        • et al.
        Obesity and the risk of heart failure.
        N Engl J Med. 2002; 347: 305-313
        • Alpert MA
        Obesity cardiomyopathy: pathophysiology and evolution of the clinical syndrome.
        Am J Med Sci. 2001; 321: 225-236
        • Alpert MA
        • Terry BE
        • Mulekar M
        • et al.
        Cardiac morphology and left ventricular function in normotensive morbidly obese patients with and without congestive heart failure, and the effects of weight loss.
        Am J Cardiol. 1997; 80: 736-740
        • Lavie CJ
        • Osman AF
        • Milani RV
        • Mehra MR
        Body composition and prognosis in chronic systolic heart failure: the obesity paradox.
        Am J Cardiol. 2003; 91: 891-894
        • Oreopoulos A
        • Padwal R
        • Kalantar-Zadeh K
        • Fonarow GC
        • Norris CM
        • McAlister FA
        Body mass index and mortality in heart failure: a meta-analysis.
        Am Heart J. 2008; 156: 13-22
        • Hunt SA
        • Abraham WT
        • Chin MH
        • American College of Cardiology Foundation/American Heart Association
        • et al.
        2009 Focused update incorporated into the ACC/AHA 2005 Guidelines for the Diagnosis and Management of Heart Failure in Adults: a Report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines.
        J Am Coll Cardiol. 2009; 53: e1-e90
        • SOLVD Investigators
        Effects of enalapril on mortality and the development of heart failure in asymptomatic patients with reduced left-ventricular ejection fractions [published correction appears in N Engl J Med. 1992;327(24):1768].
        N Engl J Med. 1992; 327: 685-691
        • Gottdiener JS
        • Arnold AM
        • Aurigemma GP
        • et al.
        Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study.
        J Am Coll Cardiol. 2000; 35: 1628-1637
        • Betti I
        • Castelli G
        • Barchielli A
        • et al.
        The role of N-terminal PRO-brain natriuretic peptide and echocardiography for screening asymptomatic left ventricular dysfunction in a population at high risk for heart failure: The PROBE-HF study.
        J Card Fail. 2009; 15: 377-384
        • Sundström J
        • Ingelsson E
        • Berglund L
        • et al.
        Cardiac troponin-I and risk of heart failure: a community-based cohort study.
        Eur Heart J. 2009; 30: 773-781
        • O'Brien PJ
        • Gwathmey JK
        Myocardial Ca2+ and ATP-cycling imbalances in end-stage dilated and ischemic cardiomyopathies.
        Cardiovasc Res. 1995; 30: 394-404
        • Bristow MR
        • Ginsburg R
        • Minobe W
        • et al.
        Decreased catecholamine sensitivity and beta-adrenergic-receptor density in the failing human heart.
        N Engl J Med. 1982; 307: 205-211
        • Sutton MG
        • Sharpe N
        Left ventricular remodeling after myocardial infarction: pathophysiology and therapy.
        Circulation. 2000; 101: 2981-2988
        • CONSENSUS Trial Study Group
        Effects of enalapril on mortality in severe congestive heart failure: results of the Cooperative North Scandinavian Enalapril Survival Study (CONSENSUS).
        N Engl J Med. 1987; 31: 1429-1435
        • Pfeffer MA
        • Braunwald E
        • Moyé LA
        • SAVE Investigators
        • et al.
        Effect of captopril on morbidity and mortality in patients with left ventricular dysfunction after myocardial infarction: results of the survival and ventricular enlargement trial.
        N Engl J Med. 1992; 327: 669-677
        • SOLVD Investigators
        Effect of enalapril on survival in patients with reduced left ventricular ejection fractions and congestive heart failure.
        N Engl J Med. 1991; 325: 293-302
        • Acute Infarction Ramipril Efficacy (AIRE) Study Investigators
        Effect of ramipril on mortality and morbidity on survivors of acute myocardial infarction with clinical evidence of heart failure.
        Lancet. 1993; 342: 821-828
        • CIBIS-II Investigators and Committees
        The Cardiac Insufficiency Bisoprolol Study II (CIBIS-II): a randomised trial.
        Lancet. 1999; 353: 9-13
        • MERIT-HF Study Group
        Effect of metoprolol CR/XL in chronic heart failure: Metoprolol CR/XL Randomised Intervention Trial in Congestive Heart Failure (MERIT-HF).
        Lancet. 1999; 353: 2001-2007
        • Packer M
        • Coats AJ
        • Fowler MB
        • Carvedilol Prospective Randomized Cumulative Survival Study Group
        • et al.
        Effect of carvedilol on survival in severe chronic heart failure.
        N Engl J Med. 2001; 344: 1651-1658
        • Vaughn DE
        Fibrinolytic balance, the renin-angiotensin system and atherosclerotic disease.
        Eur Heart J. 1998; 19: G9-G12
        • Garg R
        • Yusuf S
        • Collaborative Group on ACE Inhibitor Trials
        Overview of randomized trials of angiotensin-converting enzyme inhibitors on mortality and morbidity in patients with heart failure [published correction appears in JAMA 1995;274(6):462].
        JAMA. 1995; 273: 1450-1456
        • Bristow MR
        β-Adrenergic receptor blockade in chronic heart failure.
        Circulation. 2000; 101: 558-569
        • Kazi D
        • Deswal A
        Role and optimal dosing of angiotensin-converting enzyme inhibitors in heart failure.
        Cardiol Clin. 2008; 26 (v.): 1-14
        • Xamoterol in Severe Heart Failure Study Group
        Xamoterol in severe heart failure [published correction appears in Lancet. 1990;336(8713):698].
        Lancet. 1990; 336: 1-6
        • Beta-Blocker Evaluation and Survival Trial Investigators
        A trial of beta-blocker bucindolol in patients with advanced chronic heart failure.
        N Engl J Med. 2001; 344: 1659-1667
        • Willenheimer R
        • Van Veldhuisen DJ
        • Silke B
        • CIBIS III Investigators
        • et al.
        Effect of survival and hospitalization on initiating treatment for chronic heart failure with bisoprolol followed by enalapril, as compared with the opposite sequence: results of the randomized Cardiac Insufficiency Bisoprolol study (CIBIS) III.
        Circulation. 2005; 112: 2426-2435
        • Bristow MR
        • Gilbert EM
        • Abraham WT
        • MOCHA Investigators
        • et al.
        Carvedilol produces dose-related improvements in left ventricular function and survival in subjects with chronic heart failure.
        Circulation. 1996; 94: 2807-2816
        • Packer M
        • Poole-Wilson PA
        • Armstrong PW
        • ATLAS Study Group
        • et al.
        Comparative effects of low and high doses of the angiotensin-converting enzyme inhibitor, lisinopril, on morbidity and mortality in chronic heart failure.
        Circulation. 1999; 100: 2312-2318
        • Swedberg K
        • Eneroth P
        • Kjekshus J
        • Wilhelmsen L
        • CONSENSUS Trial Study Group
        Hormones regulating cardiovascular function in patients with severe congestive heart failure and their relation to mortality.
        Circulation. 1990; 82: 1730-1736
        • Farquharson CA
        • Struthers AD
        Spironolactone increases nitric oxide bioactivity, improves endothelial vasodilator dysfunction, and suppresses vascular angiotensin I/angiotensin II conversion in patients with chronic heart failure.
        Circulation. 2000; 101: 594-597
        • Pitt B
        • Zannad F
        • Remme WJ
        • Randomized Spironolactone Evaluation Study Investigators
        • et al.
        The effect of spironolactone on morbidity and mortality in patients with severe heart failure.
        N Engl J Med. 1999; 341: 709-717
        • Pitt B
        • Remme W
        • Zannad F
        • Eplerenone Post-Acute Myocardial Infarction Heart Failure Efficacy and Survival Study Investigators
        • et al.
        Eplerenone, a selective aldosterone blocker, in patients with left ventricular dysfunction after myocardial infarction [published correction appears in N Engl J Med. 2003;348(22):2271].
        N Engl J Med. 2003; 348: 1309-1321
        • Juurlink DN
        • Mamdani MM
        • Lee DS
        • et al.
        Rates of hyperkalemia after publication of the Randomized Aldactone Evaluation Study.
        N Engl J Med. 2004; 351: 543-551
        • Roig E
        • Perez-Villa F
        • Morales M
        • et al.
        Clinical implications of increased plasma angiotensin II despite ACE inhibitor therapy in patients with congestive heart failure.
        Eur Heart J. 2000; 21: 53-57
        • Burnier M
        • Brunner HR
        Angiotensin II receptor antagonists.
        Lancet. 2000; 355: 637-645
        • Lee VC
        • Rhew DC
        • Dylan M
        • Badamgarav E
        • Braunstein GD
        • Weingarten SR
        Meta-analysis: angiotensin-receptor blockers in chronic heart failure and high risk acute myocardial infarction [published correction appears in Ann Intern Med. 2005;42(5):391. Dosage error in article text].
        Ann Intern Med. 2004; 141: 693-704
        • Cohn JN
        • Tognoni G
        • Valsartan Heart Failure Trial Investigators
        A randomized trial of the angiotensin-receptor blocker valsartan in chronic heart failure.
        N Engl J Med. 2001; 345: 1667-1675
        • Pfeffer MA
        • McMurray JJ
        • Velazquez EJ
        • Valsartan in Acute Myocardial Infarction Trial Investigators
        • et al.
        Valsartan, captopril, or both in myocardial infarction complicated by heart failure, left ventricular dysfunction, or both [published correction appears in N Engl J Med. 2004;350(2):203].
        N Engl J Med. 2003; 349: 1893-1906
        • Ferdinand KC
        Isosorbide dinitrate and hydralazine hydrochloride: a review of efficacy and safety.
        Expert Rev Cardiovasc Ther. 2005; 3: 993-1001
        • Ignarro LJ
        • Lippton H
        • Edwards JC
        • et al.
        Mechanism of vascular smooth muscle relaxation by organic nitrates, nitrites, nitroprusside and nitric oxide: evidence for the involvement of S-nitrosothiols as active intermediates.
        J Pharmacol Exp Ther. 1981; 218: 739-749
        • Cohn JN
        • Archibald DG
        • Ziesche S
        • et al.
        Effect of vasodilator therapy on mortality in chronic congestive heart failure: results of the Veterans Administration Cooperative Study.
        N Engl J Med. 1986; 314: 1547-1552
        • Cohn JN
        • Johnson G
        • Ziesche S
        • et al.
        A comparison of enalapril with hydralazine-isosorbide dinitrate in the treatment of chronic heart failure.
        N Engl J Med. 1991; 325: 303-310
        • Taylor AL
        • Ziesche S
        • Yancy C
        • et al.
        Combination of isosorbide dinitrate and hydralazine in blacks with heart failure [published correction appears in N Engl J Med. 2005;352(12):1276].
        N Engl J Med. 2004; 351: 2049-2057
        • Gheorghiade M
        • Adams Jr, KF
        • Colucci WS
        Digoxin in the management of cardiovascular disorders.
        Circulation. 2004; 109: 2959-2964
        • Gheorgiade M
        • Ferguson D
        Digoxin: a neurohormonal modulator in heart failure?.
        Circulation. 1991; 84: 2181-2186
        • Digitalis Investigation Group
        The effect of digoxin on mortality and morbidity in patients with heart failure.
        N Engl J Med. 1997; 336: 525-533
        • Rathore SS
        • Wang Y
        • Krumholz HM
        Sex based differences in the effect of digoxin for the treatment of heart failure.
        N Engl J Med. 2002; 347: 1403-1411
        • Yamamoto K
        • Ikeda U
        • Furuhashi K
        • Irokawa M
        • Nakayama T
        • Shimada K
        The coagulation system is activated in idiopathic cardiomyopathy.
        J Am Coll Cardiol. 1995; 25: 1634-1640
        • Nguyen KN
        • Aursnes I
        • Kjekshus J
        Interaction between enalapril and aspirin on mortality after acute myocardial infarction: subgroup analysis of the Cooperative New Scandinavian Enalapril Survival Study II (CONSENSUS II).
        Am J Cardiol. 1997; 79: 115-119
        • Massie BM
        • Collins JF
        • Ammon SE
        • WATCH Trial Investigators
        • et al.
        Randomized trial of warfarin, aspirin, and clopidogrel in patients with chronic heart failure: the Warfarin and Antiplatelet Therapy in Chronic Heart Failure (WATCH) trial.
        Circulation. 2009; 119: 1616-1624
        • Packer M
        • O'Conner CM
        • Ghali JK
        • Failure Prospective Randomized Amlodipine Survival Evaluation Study Group
        • et al.
        Effect of amlodipine on morbidity and mortality in severe chronic heart failure.
        N Engl J Med. 1996; 335: 1107-1114
        • Udelson JE
        • DeAbate CA
        • Berk M
        • et al.
        Effects of amlodipine on exercise tolerance, quality of life, and left ventricular function in patients with heart failure from left ventricular systolic dysfunction.
        Am Heart J. 2000; 139: 503-510
        • Cohn JN
        • Ziesche S
        • Smith R
        • Vasodilator-Heart failure Trial (V-HeFT) Study Group
        • et al.
        Effect of the calcium antagonist felodipine as supplementary vasodilator therapy in patients with chronic heart failure treated with enalapril: V-HeFT III.
        Circulation. 1997; 96: 856-863
        • Goldstein RE
        • Boccuzzi SJ
        • Cruess D
        • Nattel S
        • Adverse Experience Committee
        • Multicenter Diltiazem Postinfarction Research Group
        Diltiazem increases late-onset congestive heart failure in postinfarction patients with early reduction in ejection fraction.
        Circulation. 1991; 83: 52-60
        • Goldsmith SR
        • Gheorghiade M
        Vasopressin antagonism and heart failure.
        J Am Coll Cardiol. 2005; 46: 1785-1791
        • Konstam MA
        • Gheorghiade M
        • Burnett Jr, JC
        • Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan (EVEREST) Investigators
        • et al.
        Effects of oral tolvaptan in patients hospitalized for worsening heart failure: the EVEREST Outcome Trial.
        JAMA. 2007; 297: 1319-1331
        • Anand I
        • McMurray J
        • Cohn JN
        • EARTH Investigators
        • et al.
        Long-term effects of darusentan on the left ventricular remodelling and clinical outcomes in the endothelinA receptor antagonist trial in heart failure (EARTH): randomised, double-blind, placebo-controlled trial.
        Lancet. 2004; 364: 347-354
        • Packer M
        • Califf RM
        • Konstam MA
        • et al.
        Comparison of omapatrilat and enalapril in patients with chronic heart failure: the Omapatrilat Versus Enalapril Randomized Trial of Utility in Reducing Events (OVERTURE).
        Circulation. 2002; 106: 920-926
        • Califf RM
        • Adams KF
        • McKenna WJ
        • et al.
        A randomized controlled trial of epoprostenol therapy for severe congestive heart failure: the Flolan International Randomized Survival Trial (FIRST).
        Am Heart J. 1997; 134: 44-54
        • Chung ES
        • Packer M
        • Lo KH
        • et al.
        Randomized, double-blind, placebo-controlled, pilot trial of infliximab, a chimeric monoclonal antibody to tumor necrosis factor-α, in patients with moderate-to-severe heart failure: results of the Anti-TNF Therapy Against Congestive Heart Failure (ATTACH) trial.
        Circulation. 2003; 107: 3133-3140
        • Mann DL
        • McMurray JJ
        • Packer M
        • et al.
        Target anticytokine therapy in patients with chronic heart failure: the results of the Randomized Etanercept Worldwide Evaluation (RENEWAL).
        Circulation. 2004; 109: 1594-1602
        • Cohn JN
        • Pfeffer MA
        • Rouleau J
        • et al.
        Adverse mortality effect of central sympathetic inhibition with sustained-release moxonidine in patients with heart failure (MOXCON).
        Eur J Heart Fail. 2003; 5: 659-667
        • Yumino D
        • Wang H
        • Floras JS
        • et al.
        Prevalence and physiological predictors of sleep apnea in patients with heart failure and systolic dysfunction.
        J Card Fail. 2009; 15: 279-285
        • Wang H
        • Parker JD
        • Newton GE
        • et al.
        Influence of obstructive sleep apnea on mortality in patients with heart failure.
        J Am Coll Cardiol. 2007; 49: 1625-1631
        • Bradley TD
        • Logan AG
        • Kimoff RJ
        • CANPAP Investigators
        • et al.
        Continuous positive airway pressure for central sleep apnea and heart failure.
        N Engl J Med. 2005; 353: 2025-2033
        • Roy D
        • Talajic M
        • Nattel S
        • Atrial Fibrillation and Congestive Heart Failure Investigators
        • et al.
        Rhythm control versus rate control for atrial fibrillation and heart failure.
        N Engl J Med. 2008; 358: 2667-2677
        • Køber L
        • Torp-Pedersen C
        • McMurray JJV
        • Dronedarone Study Group
        • et al.
        Increased mortality after dronedarone therapy for severe heart failure.
        N Engl J Med. 2008; 358: 2667-2677
        • Khan MN
        • Jaïs P
        • Cummings J
        • PABA-CHF Investigators
        • et al.
        Pulmonary-vein isolation for atrial fibrillation in patients with heart failure.
        N Engl J Med. 2008; 359: 1778-1785
        • O'Connor CM
        • Whellan DJ
        • Lee KL
        • et al.
        Efficacy and safety of exercise training in patients with chronic heart failure: HF-ACTION randomized controlled trial.
        JAMA. 2009; 301: 1439-1450
        • Flynn KE
        • Piña IL
        • Whellan DJ
        • et al.
        Effects of exercise training on health status in patients with chronic heart failure: HF-ACTION randomized controlled trial.
        JAMA. 2009; 301: 1451-1459
        • Epstein AE
        • DiMarco JP
        • Ellenbogen KA
        • et al.
        ACC/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices).
        Circulation. 2008; 117: e350-e408
        • Auricchio A
        • Kloss M
        • Trautmann SI
        • Rodner S
        • Klein H
        Exercise performance following cardiac resynchronization therapy in patients with heart failure and ventricular conduction delay.
        Am J Cardiol. 2002; 89: 198-203
        • Cleland JG
        • Daubert JC
        • Erdmann E
        • Heart Failure (CARE-HF) Study Investigators
        • et al.
        The effect of cardiac resynchronization therapy on morbidity and mortality in heart failure.
        N Engl J Med. 2005; 352: 1539-1549
        • McAlister FA
        • Eskowitz J
        • Hooton N
        • et al.
        Cardiac resynchronization therapy for patients with left ventricular systolic dysfunction: a systematic review.
        JAMA. 2007; 297: 2502-2514
        • Beshai JF
        • Grimm RA
        • Nagueh SF
        • RethinQ Study Investigators
        • et al.
        Cardiac-resynchronization therapy in heart failure with narrow QRS complexes.
        N Engl J Med. 2007; 357: 2461-2471
        • Chung ES
        • Leon AR
        • Tavazzi L
        • et al.
        Results of the Predictors of Response to CRT (PROSPECT) trial.
        Circulation. 2008; 117: 2608-2616
        • Saxon LA
        Sudden cardiac death: epidemiology and temporal trends.
        Rev Cardiovasc Med. 2005; 6: S12-S20
        • Moss AJ
        • Zareba W
        • Hall WJ
        • Multicenter Automatic Defibrillator Implantation Trial II Investigators
        • et al.
        Prophylactic implantation of a defibrillator in patients with myocardial infarction and reduced ejection fraction.
        N Engl J Med. 2002; 346: 877-883
        • Bardy GH
        • Lee KL
        • Mark DB
        • Sudden Cardiac Death in Heart Failure Trial (SCD-HeFT) Investigators
        • et al.
        Amiodarone or an implantable cardio-defibrillator for congestive heart failure [published correction appears in N Engl J Med. 2005;352(20):2146].
        N Engl J Med. 2005; 352: 225-237
        • Chow T
        • Kereiakes DJ
        • Onufer J
        • MASTER Trial Investigators
        • et al.
        Does microvolt T-wave alternans testing predict ventricular tachyarrhythmias in patients with ischemic cardiomyopathy and prophylactic defibrillators? the MASTER (Microvolt T wave Alternans Testing for Risk Stratification of Post-Myocardial Infarction Patients) trial.
        J Am Coll Cardiol. 2008; 52: 1607-1615
        • Allman KC
        • Shaw LJ
        • Hachamovitch R
        • Udelson JE
        Myocardial viability testing and impact of revascularization on prognosis in patients with coronary artery disease and left ventricular dysfunction: a meta-analysis.
        J Am Coll Cardiol. 2002; 39: 1151-1158
        • Diodato MD
        • Moon MR
        • Pasque MK
        • et al.
        Repair of ischemic mitral regurgitation does not increase mortality or improve long-term survival in patients undergoing coronary artery revascularization: a propensity analysis.
        Ann Thorac Surg. 2004; 78: 794-799
        • Jones RH
        • Velazquez EJ
        • Michler RE
        • STICH Hypothesis 2 Investigators
        • et al.
        Coronary bypass surgery with or without surgical ventricular reconstruction.
        N Engl J Med. 2009; 360: 1705-1717
        • Jong P
        • Vowinckel E
        • Liu PP
        • Gong Y
        • Tu JV
        Prognosis and determinants of survival in patients newly hospitalized for heart failure: a population-based study.
        Arch Intern Med. 2002; 162: 1689-1694
        • Haldeman GA
        • Croft JB
        • Giles WH
        • Rashidee A
        Hospitalization of patients with heart failure: National Hospital Discharge Survey, 1985 to 1995.
        Am Heart J. 1999; 137: 352-360
        • Adams Jr, KF
        • Fonarow GC
        • Emerman CL
        • ADHERE Scientific Advisory Committee and Investigators
        • et al.
        Characteristics and outcomes of patients hospitalized for heart failure in the United States: rationale, design, and preliminary observations from the first 100,000 cases in the Acute Decompensated Heart Failure Registry (ADHERE).
        Am Heart J. 2005; 149: 209-216
        • Binanay C
        • Califf RM
        • Hasselblad V
        • ESCAPE Investigators and ESCAPE Study Coordinators
        • et al.
        Evaluation study of congestive heart failure and pulmonary artery catheterization effectiveness: the ESCAPE trial.
        JAMA. 2005; 294: 1625-1633
        • Fonarow GC
        • Adams Jr, KF
        • Abraham WT
        • Yancy CW
        • Biscardin WJ
        • ADHERE Scientific Advisory Committee, Study Group, and Investigators
        Risk stratification for in-hospital mortality in acutely decompensated heart failure: classification and regression tree analysis.
        JAMA. 2005; 293: 572-580
        • Peacock IV, WF
        • De Marco T
        • Fonarow GC
        • ADHERE Investigators
        • et al.
        Cardiac troponin and outcome in acute heart failure.
        N Engl J Med. 2008; 358: 2117-2126
        • Vasko MR
        • Cartwright DB
        • Knochel JP
        • Nixon JV
        • Brater DC
        Furosemide absorption altered in decompensated congestive heart failure.
        Ann Intern Med. 1985; 102: 314-318
        • Dormans TP
        • van Meyel JJ
        • Gerlag PG
        • Tan Y
        • Russel FG
        • Smits P
        Diuretic efficacy of high dose furosemide in severe heart failure: bolus injection versus continuous infusion.
        J Am Coll Cardiol. 1996; 28: 376-382
        • Mouallem M
        • Brif I
        • Mayan H
        • Farfel Z
        Prolonged therapy by the combination of furosemide and thiazides in refractory heart failure and other fluid retaining conditions.
        Int J Cardiol. 1995; 50: 89-94
        • Mehta RH
        • Rogers JG
        • Hasselblad V
        • Evaluation Study of Congestive Heart Failure and Pulmonary Artery Catheterization Effectiveness (ESCAPE) Trial Investigators
        • et al.
        Association of weight change with subsequent outcomes in patients hospitalized with acute decompensated heart failure.
        Am J Cardiol. 2009; 103: 76-81
        • Brown JR
        • Uber PA
        • Mehra MR
        The progressive cardiorenal syndrome in heart failure: mechanisms and therapeutic insights.
        Curr Treat Options Cardiovasc Med. 2008; 10: 342-348
        • Geisberg C
        • Butler J
        Addressing the challenges of cardiorenal syndrome.
        Cleve Clin J Med. 2006; 73: 485-491
        • Weinfeld MS
        • Chertow GW
        • Stevenson LW
        Aggravated renal dysfunction during intensive therapy for advanced chronic heart failure.
        Am Heart J. 1999; 138: 285-290
        • Wencker D
        Acute cardio-renal syndrome: progression from congestive heart failure to congestive kidney failure.
        Curr Heart Fail Rep. 2007; 4: 134-138
        • Mullens W
        • Abrahams Z
        • Skouri HN
        • et al.
        Elevated intra-abdominal pressure in acute decompensated heart failure: a potential contributor to worsening renal function?.
        J Am Coll Cardiol. 2008; 51: 300-306
        • Costanzo MR
        • Guglin ME
        • Saltzberg MT
        • UNLOAD Trial Investigators
        • et al.
        Ultrafiltration versus intravenous diuretics for patients hospitalized for acute decompensated heart failure [published correction appears in J Am Coll Cardiol. 2007;49(10):1136].
        J Am Coll Cardiol. 2007; 49: 675-683
        • Mills RM
        • LeJemtel TH
        • Horton DP
        • Natrecor study group
        • et al.
        Sustained hemodynamic effects of an infusion of nesiritide (human b-type natriuretic peptide) in heart failure: a randomized, double-blind placebo-controlled clinical trial.
        J Am Coll Cardiol. 1999; 34: 155-162
        • Sackner-Bernstein JD
        • Skopicki HA
        • Aaronson KD
        Risk of worsening renal function with nesiritide in patients with acutely decompensated heart failure [published correction appears in Circulation. 2005;111(17):2274].
        Circulation. 2005; 111: 1487-1491
        • O'Connor CM
        • Gattis WA
        • Uretsky BF
        • et al.
        Continuous intravenous dobutamine is associated with an increased risk of death in patients with advanced heart failure: insights from the Flolan International Randomized Survival Trial (FIRST).
        Am Heart J. 1999; 138: 78-86
        • Cuffe MS
        • Califf RM
        • Adams Jr, KF
        • Outcomes of a Prospective Trial of Intravenous Milrinone for Exacerbations of Chronic Heart Failure (OPTIME-CHF) Investigators
        • et al.
        Short-term intravenous milrinone for acute exacerbation of chronic heart failure: a randomized controlled trial.
        JAMA. 2002; 287: 1541-1547
        • Buckley MJ
        • Leinbach RC
        • Kastor JA
        • et al.
        Hemodynamic evaluation of intra-aortic balloon pumping in man.
        Circulation. 1970; 41: II130-II136
        • Dilley RB
        • Ross Jr, J
        • Bernstein EF
        Serial hemodynamics during intra-aortic balloon counterpulsation for cardiogenic shock.
        Circulation. 1973; 48: III99-III104
        • Miller LW
        • Pagani FD
        • Russel SD
        • HeartMate II Clinical Investigators
        • et al.
        Use of a continuous-flow device in patients awaiting heart transplantation.
        N Engl J Med. 2007; 357: 885-896
        • Lietz K
        • Long JW
        • Kfoury AG
        • et al.
        Outcomes of left ventricular assist device implantation as destination therapy in the post-REMATCH era: implications for patient selection.
        Circulation. 2007; 116: 497-505
        • Redfield MM
        • Jacobsen SJ
        • Burnett Jr, JC
        • Mahoney DW
        • Bailey KR
        • Rodeheffer RJ
        Burden of systolic and diastolic ventricular dysfunction in the community: appreciating the scope of the heart failure epidemic.
        JAMA. 2003; 289: 194-202
        • Masoudi FA
        • Havranek EP
        • Smith G
        • et al.
        Gender, age, and heart failure with preserved systolic function.
        J Am Coll Cardiol. 2003; 41: 217-223
        • Senni M
        • Redfield MM
        Heart failure with preserved systolic function: a different natural history?.
        J Am Coll Cardiol. 2001; 38: 1277-1282
        • Tan YT
        • Wenzelburger F
        • Lee E
        • et al.
        The pathophysiology of heart failure with normal ejection fraction; exercise echocardiography reveals complex abnormalities of both systolic and diastolic ventricular function involving torsion, untwist, and longitudinal motion.
        J Am Coll Cardiol. 2009; 54: 36-46
        • Kitzman DW
        • Higginbotham MB
        • Cobb FR
        • Sheikh KH
        • Sullivan MJ
        Exercise intolerance in patients with heart failure with preserved systolic function: failure of the Frank-Starling mechanism.
        J Am Coll Cardiol. 1991; 17: 1065-1072
        • Lubien E
        • DeMaria A
        • Krishnaswamy P
        • et al.
        Utility of B-natriuretic peptide in detecting diastolic dysfunction: comparison with Doppler velocity recordings [published correction appears in Circulation. 2002;106(3):387].
        Circulation. 2002; 105: 595-601
        • Klingbeil AU
        • Schneider M
        • Martus P
        • Messerli FH
        • Schmieder RE
        A meta-analysis of the effects of treatment of left ventriclular mass in essential hypertension.
        Am J Med. 2003; 115: 41-46
        • Solomon SD
        • Janardhanan R
        • Verma A
        • Valsartan In Diastolic Dysfunction (VALIDD) Investigators
        • et al.
        Effect of angiotensin receptor blockade and antihypertensive drugs on diastolic function in patients with hypertension and diastolic dysfunction: a randomised trial.
        Lancet. 2007; 369: 2079-2087
        • Yusuf S
        • Pfeffer MA
        • Swedberg K
        • CHARM Investigators and Committees
        • et al.
        Effects of candesartan in patients with chronic heart failure and preserved left-ventricular ejection fraction: the CHARM-Preserved Trial.
        Lancet. 2003; 362: 777-781
        • Massie BM
        • Carson PE
        • McMurray JJ
        • I-PRESERVE Investigators
        • et al.
        Irbesartan in patients with heart failure and preserved ejection fraction.
        N Engl J Med. 2008; 359: 2456-2467
        • Ahmed A
        • Rich MW
        • Fleg Jl
        • et al.
        Effect of digoxin on morbidity and mortality in diastolic heart failure: the ancillary digitalis investigation group trial.
        Circulation. 2006; 114: 397-403
        • Hernandez AF
        • Hammil BG
        • O'Connor CM
        • et al.
        Clinical effectiveness of beta-blockers in heart failure: findings from the OPTIMIZE-HF (Organized program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure) registry.
        J Am Coll Cardiol. 2009; 53: 184-192
        • Goldberg LR
        • Jessup M
        A time to be born and a time to die [editorial].
        Circulation. 2007; 116: 360-362
        • Aaronson KD
        • Schwartz JS
        • Chen TM
        • Wong KL
        • Goin JE
        • Mancini DM
        Development and prospective validation of a clinical index to predict survival in ambulatory patients referred for cardiac transplant evaluation.
        Circulation. 1997; 95: 2660-2667
        • Kolling TM
        • Joseph S
        • Aaronson KD
        Heart failure survival score continues to predict clinical outcomes in patients with heart failure receiving β-blockers.
        J Heart Lung Transplant. 2004; 23: 1414-1422
        • Levy WC
        • Mozaffarian D
        • Linker DT
        • et al.
        The Seattle Heart Failure Model: prediction of survival in heart failure.
        Circulation. 2006; 113: 1424-1433
        • Mozaffarian D
        • Anker SK
        • Anand I
        • et al.
        Prediction of mode of death in heart failure: the Seattle Heart Failure Model.
        Circulation. 2007; 116: 392-398
        • Setoguchi S
        • Stevenson LW
        • Schneeweiss S
        Repeated hospitalizations predict mortality in the community population with heart failure.
        Am Heart J. 2007; 154: 260-266
        • Fonarow GC
        • Abraham WT
        • Albert NM
        • OPTIMIZE-HF Investigators and Hospitals
        • et al.
        Influence of a performance-improvement initiative on quality of care for patients hospitalized with heart failure: results of the Organized Program to Initiate Lifesaving Treatment in Hospitalized Patients with Heart Failure (OPTIMIZE-HF).
        Arch Intern Med. 2007; 167: 1493-1502
        • Mancini DM
        • Eisen H
        • Kussmaul W
        • Mull R
        • Edmunds Jr, LH
        • Wilson JR
        Value of peak exercise oxygen consumption for optimal timing of cardiac transplantation in ambulatory patients with heart failure.
        Circulation. 1991; 83: 778-786
        • Taylor DO
        • Edwards LB
        • Aurora P
        • et al.
        Registry of the International Society of Heart and Lung Transplantation: twenty-fifth official adult heart transplant report—2008.
        J Heart Lung Transplant. 2008; 27: 943-956
        • Morgan JA
        • John R
        • Weinberg AD
        • et al.
        Long-term results of cardiac transplantation in patients 65 years of age and older: a comparative analysis.
        Ann Thorac Surg. 2003; 76: 1982-1987
        • Kriz W
        Adenosine and ATP: traffic regulators in the kidney.
        J Clin Invest. 2004; 114: 611-613
        • Givertz MM
        • Massie BM
        • Fields TK
        • et al.
        The effects of KW-3902, an adenosine A1-receptor antagonist on diuresis and renal function in patients with acute decompensated heart failure and renal impairment or diuretic resistance.
        J Am Coll Cardiol. 2007; 50: 1551-1560
        • Mozaffarian D
        • Nye R
        • Levy WC
        Anemia predicts mortality in severe heart failure: the prospective randomized amlodipine survival evaluation (PRAISE).
        J Am Coll Cardiol. 2003; 41: 1933-1939
        • Adams Jr, KF
        • Patterson JH
        • Orem RM
        • STAMINA-HFP Registry Investigators
        • et al.
        Prospective assessment of the occurrence of anemia in patients with heart failure: results from the Study of Anemia in a Heart Failure Population (STAMINA-HFP) Registry.
        Am Heart J. 2009; 157: 926-932
        • Parissis JT
        • Kourea K
        • Andreadou I
        • et al.
        Effects of Darbepoetin Alfa on plasma mediators of oxidative and nitrosative stress in anemic patients with chronic heart failure secondary to ischemic or idiopathic dilated cardiomyopathy.
        Am J Cardiol. 2009; 103: 1134-1138
        • Gissi-HF Investigators
        Effect of n-3 polyunsaturated fatty acids in patients with chronic heart failure (the GISSI-HF trial): a randomised, double-blind, placebo-controlled trial.
        Lancet. 2008; 372: 1223-1230