Need and prospects for prevention of cardiac failure.

Cardiac failure is a lethal end-stage of cardiovascular disease. Survival, once the heart has used up all its reserve and compensatory mechanisms, is little better than for cancer. Once overt failure ensues median survival is only 1.7 years for men and 3.2 years for women, and sudden death is a common mode of exitus. Recent declines in death rates from cardiac disease have not been accompanied by a reduced prevalence or incidence of cardiac failure. A substantial reduction in cardiac failure incidence and mortality requires the detection and correction of presymptomatic left ventricular dysfunction and the risk factors which predispose to its occurrence. Major contributors to the development of cardiac failure have been delineated and quantified. Methods for efficiently identifying presymptomatic candidates for cardiac failure for preventive measures have been developed. High-risk candidates can now be cost-effectively targeted for treatment to delay failure. Independent predictors of heart failure have been identified by epidemiologic research which enable construction of multivariable risk profiles that efficiently predict congestive heart failure (CHF). The conditional probability of an event can be estimated over a wide range using a logistic function including the variables of age, systolic blood pressure, vital capacity, heart rate, ECG-LVH, X-ray cardiac enlargement, glucose intolerance, and coronary heart disease or valvular deformity. In this way it is possible to identify high-risk candidates for CHF. Some 80% of CHF events occur in persons in the upper quintile of multivariate risk. These persons at high risk yield a high prevalence of persons with echocardiographic evidence of impaired cardiac function likely to benefit from vigorous preventive management including angiotensin-converting enzyme (ACE) inhibitors.