Cardiology Topic Homepage

Heart Failure

Heart Failure

Heart Failure is a progressive chronic disorder that results in the inability of the heart to pump blood efficiently to the body’s tissues.

Chronic heart failure is an increasing public health problem; the growing prevalence in industrialised countries means that 1-2% of the adult population of these countries are now thought to have chronic heart failure.1-3 Estimates suggest that the prevalence in Europe, USA and Japan could increase by approximately 16.5% over the next ten years.4

The prevalence of post-myocardial infarction heart failure is less well known as it is difficult to distinguish between pre-existing and incident heart failure. However current estimates suggest that approximately 1 in 5 patients hospitalised with an acute coronary syndrome either present with heart failure or develop heart failure during their hospital stay.5

Many of the signs and symptoms of heart failure are non-specific and vary in severity depending on the disease class. The most common of these are breathlessness, fatigue, exercise intolerance, and fluid retention as evidenced by ankle swelling, peripheral oedema, and an elevated jugular venous pressure.6

Due to the non-specific nature of symptoms, the diagnosis of heart failure can be difficult. Tests can include echocardiogram, ECG, chest X-ray, laboratory tests. Following a positive diagnosis heart failure is classified into functional classes that relate to disease severity.

Management of heart failure involves lifestyle modifications, pharmacological treatment and occasionally surgery. In patients with chronic heart failure, optimal therapy involves treatment with diuretics, ACE inhibitors, certain β-blockers and a mineralocorticoid receptor antagonist.

The Heart Failure Knowledge Centre brings together current information related to chronic heart failure and post-myocardial infarction, including:

  • Epidemiology
  • Symptoms and Diagnosis
  • Classification
  • Treatment Options

Enter the Heart Failure Knowledge Centre


  1. Zannad F, et al. Incidence, clinical and etiologic features, and outcomes of advanced chronic heart failure: the EPICAL Study. Journal of the American College of Cardiology 1999; 33(3):734-742.
  2. Cowie MR, et al. The epidemiology of heart failure. European Heart Journal 1997;18(2):208-225.
  3. Mosterd A, Hoes A. Clinical epidemiology of heart failure. Heart 2007; 93:1137-1146.
  4. Decision Resources. Chronic Heart Failure. Cardium Study No.4 A Pharmacor Service. 2008.
  5. Steg PG, Dabbous OH, et al. Determinants and prognostic impact of heart failure complicating acutecoronary syndromes. Observations from the Global Registry of Acute Coronary Events (GRACE). Circulation2004;109:494-9.
  6. NICE Clinical Guideline No 108. Chronic Heart Failure. National clinical guideline for diagnosis and management in primary and secondary care. 2010.

Type 2 Diabetes

,Type 2 Diabetes CME and Knowledge Centre

Based on current estimates, the global prevalence of Type 2 diabetes mellitus has increased almost 10 fold since 1985 and is expected to rise to 552 million by 2030,1 and when absolute numbers of people with diabetes are considered, it is South East Asia and the West Pacific that are expected to experience the highest increases in prevalence over the coming years.2

An EACCME accredited CME is available, awarded 1 European CME credits (ECMEC's). Consisting of 3 modules:

  • A Review of Newer Therapies for Type 2 Diabetes in Combination with Insulin, John Wilding (Chair)
  • Identifying and Managing the Psychosocial Aspects of Type 2 Diabetes Mellitus, Richard Holt (Faculty)
  • Potential Role of Newer Therapies for Type 2 Diabetes in Combination with Insulin: Interactive Case Discussion, Bernard Charbonnel (Faculty)

Take CME now

The Type 2 Diabetes Knowledge Centre aims to provide clear and concise information based on current accepted guidelines on the treatment and management of patients with this disease. In addition the Knowledge Centre also provides access to key guidelines and a review of treatment options available.

Visit Knowledge Centre 


  1. Murea M, Ma L, Freedman BI. Genetic and environmental factors associated with type 2 diabetes and diabetic vascular complications. Rev Diabetic Studies 2012;9:6-22.
  2. International Diabetes Federation. Diabetes atlas: second edition. 2002. Available at: (accessed 18 November 2013).


Clinical Case Studies

MRSA Endocarditis

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Christopher D. Pfeiffer, Clinical Fellow, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA
Vance Fowler, Associate Professor and Infectious Diseases, Specialist, Department of Medicine, Duke University Medical Center, Durham, North Carolina, USA

Case History
A 64-year-old female presented with three weeks of progressive dyspnoea, nausea and vomiting.

Vascular Graft Infection

Infection: Cardiovascular Infections

Stephanie J. Dancer BSc, MB BS, MSc, MD, FRCPath, DTM&H, Consultant Microbiologist, NHS Lanarkshire, Scotland

Case History
A 72-year-old man was referred by his general practitioner complaining of intermittent pain in the legs on exercise.

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The objective is to compare the efficacy of 2 treatment strategies, catheter ablation of atrial fibrillation versus optimized pharmacological therapy, in patients with symptomatic atrial fibrillation.

It is a randomized, prospective, controlled, open-label multicentre, parallel-group..

... study including 116 patients. Inclusion criteria are patients aged 30-70 years with symptoms related to atrial fibrillation and who have failed or been intolerant to at least one anti-arrhythmic drug, with at least one atrial fibrillation episode documented on ECG during the previous 12 months and at least one symptomatic episode during the previous 2 months or at least 2 symptomatic episodes of persistent AF in the previous 12 months.

Main exclusion criteria are patients who have tested 2 or more anti-arrhythmic drugs for rhythm control, uncontrolled hypertension, valvular disease requiring anticoagulation, planned valve surgery within 2 years, contraindication to treatment with anticoagulants, heart failure, left atrial diameter > 60 mm, unstable angina or acute myocardial infarction within the last 3 months, cardiac revascularization procedure within the last 6 months, prior cardiac surgery or planned cardiac corrective surgery within 1 year, prior AF ablation procedure.

The primary endpoint is general health-related quality of life at 12 months follow-up. The main secondary endpoints are morbidity and mortality as composite outcome, cardiovascular hospitalization, symptoms, heart failure, left atrial and ventricular function and diameters, exercise capacity, health care economics, rhythm, atrial fibrillation burden, successful versus failed treatment, safety and "cross-overs" over time.

Patients will receive a cardiac monitor, implanted subcutaneously, which will monitor the heart rhythm during a two month "Run-in" period, for the definition of the basic atrial fibrillation burden. Patients will be randomly assigned to an antiarrhythmic drug (for rhythm or rate control) or to left atrial catheter ablation. Evaluation of outcome is at 12, 24, 36 and 48 months of follow-up, while health economy will be evaluated at 24 and 48 months of follow-up.. In case of documented disease progression or unacceptable toxicity, subjects will be switched to the alternative regimen. The main statistical analysis of the primary endpoint will be based on the intention-to-treat population. The trial duration is 48 months.

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