Heart failure is a varied clinical syndrome with a complex pathophysiology that is still being defined. These features have led to demanding therapeutic regimens that have made optimal management of heart failure a difficult enterprise. In addition, heart failure is common, and its public heath consequences are ever growing. An estimated 4.8 million individuals are afflicted with this syndrome in the United States today, and 400,000 to 700,000 new cases are estimated to develop each year. The prevalence of heart failure increases with age; it approaches 10% of Americans in the ninth decade of life. Aging of the population and the prolonged survival of patients with a variety of cardiovascular diseases that culminate in ventricular dysfunction ensure that the magnitude of the heart failure problem will substantially worsen in the next decade. Experts have projected a 2- to 3-fold increase in prevalence. In addition to being a common condition, heart failure causes substantial morbidity with total hospitalizations, directly and indirectly related, exceeding three million per year.

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