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Evaluation and therapy for heart failure in the setting of ischemic heart disease.

In the United States (US) it is estimated that 16,800,000 people have a history of coronary heart disease, including myocardial infarction (MI), angina pectoris, or both. The most common cause of chronic heart failure (HF) is no longer hypertension or valvular heart disease; it is coronary artery disease (CAD). The changing pattern in the risk factors for HF is evidenced in the Framingham Heart Study, which documents a decrease in valvular disease and left ventricular (LV) hypertrophy and an increase in MI from 1950 to 1998. As survival from MI continues to improve, it is expected that the number of patients with CAD and HF will also increase. In 25 multicenter HF treatment trials reported in the New England Journal of Medicine over the past 20 years, involving more than 45,000 patients, CAD was present in nearly 65%. This figure probably underestimates the true prevalence of CAD among unselected HF patients, because the presence of CAD was not explored systematically in many trials.