Cardiac impairment or heart failure?

“There is no disease that you either have or don't have—except perhaps sudden death or rabies. All other diseases you either have a little or a lot of,” said Geoffrey Rose.1 This is true of “heart failure”—everybody can have a bit if they try hard enough, by physical exertion or even by emotional shock.2 But, apart from transient induced cardiac overload, the term can be used to mean anything from asymptomatic systolic dysfunction to imminent death from pulmonary oedema. Because of widely varying definitions, the epidemiology of heart failure can become almost uninterpretable, with estimates of its prevalence in the United Kingdom varying from 500 000 to 3 million.3 Moreover, qualitative studies show that many patients are never told that they have heart failure because doctors are understandably reluctant to use the term.4 When a label confuses doctors and impairs communication with patients, it seems sensible to change the label.

The recent increase in interest in heart failure began with interventional studies among highly selected patients. They were mainly men aged 60-65 on average, with a history of myocardial infarction …