Vnitr Lek 2004, 50(Supplement 1):S23-S31

[Heart failure--epidemic of the 21st century].

J Hradec: III. interní klinika 1. LF UK a VFN, Praha.

Number of patients with chronic heart failure is increasing in all developed countries. The reasons are both, the improving prevention and treatment of deadly cardiovascular diseases, like acute myocardial infarction or stroke, and the increasing life expectancy. The cardiovascular mortality has declined by 30% and the average life expectancy has increased by 4 years also in the Czech Republic during the last 15 years. The prevalence of heart failure is about 1.5% in a general population, which means that there is about 150,000 patients in the Czech Republic. The annual incidence is about 0.4%, which means that there is about 40,000 new patients in the Czech Republic every year. The prevalence is increasing with age significantly. With respect to the ageing of the population it is expected that number of heart failure patients will be increasing. Based on the results of big clinical trials the treatment of heart failure has changed significantly. ACE inhibitors and beta-blockers became the first choice treatment improving not only symptoms but also mortality. In spite of all the progress in pharmacotherapy the prognosis of heart failure is still bad. Over 40% of patients will die within 4 years after making the diagnosis of heart failure and one-year mortality of patients with advanced heart failure (NYHA class IV) is over 50%. Therefore, a research of new therapeutic possibilities is still continuing. At present, a clinical significance of different devices, like biventricular cardiac pacemakers (cardiac resynchronization therapy) or implantable cardioverter/defibrillators in heart failure treatment is studied. A gene and cell therapy represents a great hope for heart failure treatment in future.