Clinical and economic factors in the treatment of congestive heart failure.

Congestive heart failure (CHF) is a disease of massive clinical and economic importance throughout the developed world. Approximately 1% of the population are affected, with incidence and prevalence of CHF increasing with age. The major aetiological factor is ischaemic heart disease and, despite advances in treatment, mortality from CHF remains appallingly high, and comparable to that of many malignancies. The majority of patients with CHF require treatment with a diuretic, though there is now clear evidence that the addition of an angiotensin converting enzyme (ACE) inhibitor will not only improve symptoms but also reduce mortality and delay the progression of the disease. The vast economic impact of CHF is now becoming fully appreciated, with the majority of expenditure on hospital admissions. The earlier and more widespread use of ACE inhibitors in the treatment of CHF would be highly cost effective, with substantial savings in hospitalisation costs, though new and effective treatments are still urgently required.