SELF-ASSESSMENT
Netherlands Institute for Continuing Cardiovascular Education (CVOI) self-assessment In collaboration with Mediselect and supported by the company Novartis, the textbook Heart Failure, edited by Dirk Jan van Veldhuisen and Adriaan Voors, was published in Autumn 2003.
This textbook was primarily intended for the cardiology training course (OCC) in 2003. In like manner, the CVOI intends to publish textbooks on Atherosclerosis and Thrombosis in 2004 and Electrocardiography and Electrophysiology in 2005. Following publication ofthe book, brief focused reviews of its chapters will be published in consecutive issues ofthe Netherlands Heart Joumal. After each of these articles, there will be two multiple-choice questions, which can be answered in the section Questions & Answers ofthe website ofthe CVOI, www.cvoi.org. Correct answers will be honoured with 1 credit, while wrong answers to one or both questions will connect the participant to a section that presents and discusses the correct answers, after which the procedure can be repeated. Correct answers to both questions will automatically lead to registration of the CME credits in the Cardiologist Registration Accreditation System (CRAS) on the CVOI website. All textbooks contain eight chapters; participants can therefore obtain 16 credit points. This experiment that connects CME articles to web-based self-assessment programmes and accreditation may pave the way for similar future developments and a reliable verifiable accreditation of CME articles.
Heart failure: chapter 2 Epidemiology: prevalence, incidence, prognosis A.W. Hoes, A. Mosterd
Cardiovascular disease is the most important cause of death in the industrialised world. The contribution ofheart failure (HF) to cardiovascular death is increasing. In the Netherlands over 1% ofhealthcare expenditure is spent on HF and this percentage will increase with the disproportionate increase in old people and a better survival of coronary artery disease, the main contributor to HF. Research pays more attention to therapy than to prevalence, incidence and prognosis, but these data are needed to estimate probability and natural course and to decide on diagnosis and therapy.
Definition(s) of heart failure The many definitions of HF hinder a comparison of studies and an understanding of incidence and trends in time. Of notice is the ongoing discussion on systolic or diastolic HF (or better, HF with preserved systolic
Correspondence to: A. Mosterd E-mail: [email protected]
Netherlands Heart Journal, Volume 12, Number 5, May 2004
function) as well as on the fact that many patients with left ventricular (LV) dysfunction are asymptomatic. Moreover many patients are diagnosed and treated by family doctors who do not objectivate pump failure, but act pragmatically, for example by relying on reaction to loop diuretics. The Dutch Multidisciplinary Guideline on Chronic Heart Failure defines HF as 'a complex of signs and symptoms caused by failure of the pump function of the heart'. The guideline distinguishes between HF with impaired LV systolic function (systolic HF) and HF with normal or preserved LV systolic function (diastolic HF). Of crucial importance in this and in other definitions is the combination of signs and symptoms and pump failure. Asymptomatic LV dysfunction is not synonymous with HF but can be a precursor of HF. In the three-year follow-up of participants in the placebo arm of the SOLVDprevention trial (asymptomatic ejection fraction of 35% or lower) 30% of patients developed manifest HF and 13% were hospitalised for the first time with symptoms of HF. 235
Chapter 2: Epidemiology: prevalence, incidence, prognosis
1614-
212'-
+
*
Men
*
Women
Roterdam
e-
50
London
45 t
40 /
10 -
.0
8642-
I
35 30 25 20-
15 10 0
a
0-
55-64
65-74
75-84
,85
S
Total
Ag (years) Figure 1. Prevalence of heart failure in the Netherlands. Rotterdam ERGO study.
The
Prevalence Prevalence is defined as the number of cases of a disorder in a given population at a specific period in time (period p), or at a particular moment in time (point p) (figure 1). Estimations of the prevalence of HF in the Netherlands vary from 165,000 to 200,000 cases. The wide variance is no surprise. Most studies only combine questionnaires, patient records, medical history (hypertension and CAD), cardiovascular drug therapy and physical examination. A minority of studies include chest X-rays and ECGs. Studies that include echocardiography are rare. Nonetheless, all studies show an increase in prevalence with age. The first study that objectivated LV function with two-dimensional echocardiography included 1467 participants in Glasgow (mean age 50 years, 48% male). HF was defined as the combination of an ejection fraction
Netherlands Institute for Continuing Cardiovascular Education (CVOI) self-assessment In collaboration with Mediselect and supported by the company Novartis, the textbook Heart Failure, edited by Dirk Jan van Veldhuisen and Adriaan Voors, was published in Autumn 2003.
This textbook was primarily intended for the cardiology training course (OCC) in 2003. In like manner, the CVOI intends to publish textbooks on Atherosclerosis and Thrombosis in 2004 and Electrocardiography and Electrophysiology in 2005. Following publication ofthe book, brief focused reviews of its chapters will be published in consecutive issues ofthe Netherlands Heart Joumal. After each of these articles, there will be two multiple-choice questions, which can be answered in the section Questions & Answers ofthe website ofthe CVOI, www.cvoi.org. Correct answers will be honoured with 1 credit, while wrong answers to one or both questions will connect the participant to a section that presents and discusses the correct answers, after which the procedure can be repeated. Correct answers to both questions will automatically lead to registration of the CME credits in the Cardiologist Registration Accreditation System (CRAS) on the CVOI website. All textbooks contain eight chapters; participants can therefore obtain 16 credit points. This experiment that connects CME articles to web-based self-assessment programmes and accreditation may pave the way for similar future developments and a reliable verifiable accreditation of CME articles.
Heart failure: chapter 2 Epidemiology: prevalence, incidence, prognosis A.W. Hoes, A. Mosterd
Cardiovascular disease is the most important cause of death in the industrialised world. The contribution ofheart failure (HF) to cardiovascular death is increasing. In the Netherlands over 1% ofhealthcare expenditure is spent on HF and this percentage will increase with the disproportionate increase in old people and a better survival of coronary artery disease, the main contributor to HF. Research pays more attention to therapy than to prevalence, incidence and prognosis, but these data are needed to estimate probability and natural course and to decide on diagnosis and therapy.
Definition(s) of heart failure The many definitions of HF hinder a comparison of studies and an understanding of incidence and trends in time. Of notice is the ongoing discussion on systolic or diastolic HF (or better, HF with preserved systolic
Correspondence to: A. Mosterd E-mail: [email protected]
Netherlands Heart Journal, Volume 12, Number 5, May 2004
function) as well as on the fact that many patients with left ventricular (LV) dysfunction are asymptomatic. Moreover many patients are diagnosed and treated by family doctors who do not objectivate pump failure, but act pragmatically, for example by relying on reaction to loop diuretics. The Dutch Multidisciplinary Guideline on Chronic Heart Failure defines HF as 'a complex of signs and symptoms caused by failure of the pump function of the heart'. The guideline distinguishes between HF with impaired LV systolic function (systolic HF) and HF with normal or preserved LV systolic function (diastolic HF). Of crucial importance in this and in other definitions is the combination of signs and symptoms and pump failure. Asymptomatic LV dysfunction is not synonymous with HF but can be a precursor of HF. In the three-year follow-up of participants in the placebo arm of the SOLVDprevention trial (asymptomatic ejection fraction of 35% or lower) 30% of patients developed manifest HF and 13% were hospitalised for the first time with symptoms of HF. 235
Chapter 2: Epidemiology: prevalence, incidence, prognosis
1614-
212'-
+
*
Men
*
Women
Roterdam
e-
50
London
45 t
40 /
10 -
.0
8642-
I
35 30 25 20-
15 10 0
a
0-
55-64
65-74
75-84
,85
S
Total
Ag (years) Figure 1. Prevalence of heart failure in the Netherlands. Rotterdam ERGO study.
The
Prevalence Prevalence is defined as the number of cases of a disorder in a given population at a specific period in time (period p), or at a particular moment in time (point p) (figure 1). Estimations of the prevalence of HF in the Netherlands vary from 165,000 to 200,000 cases. The wide variance is no surprise. Most studies only combine questionnaires, patient records, medical history (hypertension and CAD), cardiovascular drug therapy and physical examination. A minority of studies include chest X-rays and ECGs. Studies that include echocardiography are rare. Nonetheless, all studies show an increase in prevalence with age. The first study that objectivated LV function with two-dimensional echocardiography included 1467 participants in Glasgow (mean age 50 years, 48% male). HF was defined as the combination of an ejection fraction
![[Epidemiology and prognosis of heart failure].](/assets/img/hold.png)
