Most heart failure research and quality improvement efforts are targeted at treatment and secondary prevention of patients with manifest heart failure. This is distinct from coronary disease where primary prevention has been a focus for over three decades. Given the current importance and the projected worsening of heart failure epidemiology, a more focused effort on prevention is urgently needed. 1. Epidemiology It is estimated that over 5.5 million subjects in the United States have heart failure and more than 650,000 are diagnosed for the first time each year [1]. Patients with impaired versus preserved left ventricular systolic function related heart failure each comprises about half of the overall burden of heart failure in the community [2, 3]. The proportion of heart failure with preserved ejection fraction increases with age [2]. Heart failure is the primary reason for 12–15 million office visits and 6.5 million hospital days annually. Recurrent hospitalization is a major issue with the annual number of hospitalizations now exceeding over 1 million for heart failure. These patients are particularly prone to rehospitalizations with readmission rates near 50% within six months of discharge. It has been estimated that the total direct and indirect cost of heart failure in the United States exceeds $ 30 billion [1]. The outcomes of these patients continue to remain suboptimal with only approximately 50% of the individuals surviving past five years after diagnosis [4]. Quality of life remains poor. Some improvement have been shown in individuals with systolic dysfunction, with no major advances in therapy for either patients with heart failure and preserved ejection fraction or those who are hospitalized for heart failure. Heart failure prevalence is rising and this trend will worsen. This is attributed to the increasing elderly population and the increasing prevalence of cardiovascular risk factors like diabetes and obesity. The aging of the 78 million baby boomers will result in 1 in 5 Americans to be over the age of 65 years by 2050. Heart failure incidence and prevalence are the highest amongst the elderly, and 80% of patients hospitalized with heart failure are over 65 years old. Thus the increasing age of the population is expected to significantly worsen the current heart failure epidemic. 2. Risk Factors Risk factors for heart failure range from lifestyle factors to comorbidities, medications, laboratory, and imaging characteristics to novel biomarkers and genomic markers [5]. Heart failure risk increases with age and male gender is
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