Congestive heart failure

Despite pharmacologic and technologic advances, heart failure remains a fundamental concern of the health care industry around the world. New medications, surgical procedures, pacemakers, and other advances in treatment have slowed disease progression; nevertheless, approximately 550,000 new cases are diagnosed each year, and nearly 5 million Americans are living with heart failure. The incidence and complexity of this disease has propelled it to the cardiovascular forefront. Very little scientific information is definitively known about the pathophysiology of heart failure, and what information is known has only been discovered in the last 25 years. Research into the mechanisms and progression of heart failure continues, and each year brings a little more new information into the scientific arena. As soon as an article or book chapter is published, it seems that new data evolves and the printed material is immediately out of date.

In this issue of the Critical Care Nursing Clinics of North America, a number of heart failure experts have contributed some very informative articles to enhance the reader's understanding of this disease. The issue begins with pathophysiology and neurohormone activation, which are the basis of all treatments. Ventricular remodeling is a complex process that is, at best, only beginning to be understood. New information on neurohormone activation regularly surfaces from the scientific community, and this information forms the basis of current and future pharmacological treatments. Angiotensin-converting enzyme inhibitors, angiotensin receptor blockers, and beta blockers are currently the foundation of pharmacological treatment and have impacted morbidity and mortality of this disease more than any other medication. Other and perhaps more controversial drugs for heart failure include digoxin and diuretics. While these drugs do not directly treat the failing heart, they have been used by health care providers for many years. Newer therapies such as nesiritide infusion and biventricular pacing have been born out of the heart failure research community and are showing promise in the treatment of this disease and its symptoms. Although heart failure is not traditionally managed surgically, there are new surgical techniques that are currently being explored; in addition, heart transplantation has matured tremendously over the last 20 years and is an end-stage treatment. New questions of appropriate treatment strategies arise as the number of patients recognized to have preserved systolic function increases, yet there are large gaps in the understanding of diastolic dysfunction. Chronic heart failure is a disease that can be well managed in an outpatient clinic, usually maintained by an advanced practice nurse. These clinics have been shown to increase the quality of life for patients with heart failure and to decrease hospital readmissions.

This issue of the Critical Care Nursing Clinics of North America is devoted to heart failure pathology, medications (old, new, and yet to come), technological advances, management strategies, and quality of life. We even added some patient management case studies. The possible topics surrounding heart failure create a rather long list, and this issue could have easily had twice as many articles. The contributors have done a wonderful job in presenting cutting edge information about heart failure as we know it today. There is so much to say about heart failure and still so much to learn. Scientists have only begun to scratch the surface in the understanding and treatment of this disease. I hope this issue will cover some of the critical information, leaving the reader hungry to pursue continued education in heart failure.