The new epidemiology of heart failure.

In the past 5 years there has been a significant shift in the focus of heart failure epidemiology research. In the 1960 to 1995 era, persons with overt clinical heart failure were identified by assessment of typical symptoms and signs of heart failure. Recent work has gone beyond symptoms and signs, to include objective echocardiographic measurement of ventricular function. This approach has revealed that most cases of ventricular dysfunction are asymptomatic. It has also underscored the high prevalence of diastolic ventricular dysfunction in the very elderly. Nevertheless, recent data suggest that advances in heart failure therapy may be resulting in improved survival for heart failure patients in the community. Future efforts need to be directed toward early detection of ventricular dysfunction and prevention of symptomatic heart failure.