Heart failure is the only cardiovascular disease that is increasing. The impact on the critical care environment and the health care system, as a whole, is significant from both a cost and burden to the system perspective. There are 6.5 million hospital days a year and nearly $40 billion dollars in yearly health care costs attributed to heart failure in the United States. There are more Medicare monies spent for diagnosing and treating heart failure than any other Diagnosis Related Group. There is a 24% hospital re-admission rate for this diagnosis which leads to financial implications for health care systems. The human cost is also significant. Less than half of Americans diagnosed with heart failure survive greater than 5 years. The ongoing health care needs and cost of this chronic disease takes a significant toll on patients’ finances, time and quality of life. Over $2.9 billion dollars is spent annually on the pharmaceutical management of heart failure in the United States. This diagnosis is the leading cause of hospitalization for patients who are 65 years of age and older. Few health care providers in the critical care environment are not affected by heart failure on a routine basis. Caring for these patients and their families is both a challenging and yet a rewarding experience. This edition will provide critical care nurses with a comprehensive heart failure review which is essential in caring for this challenging population given the dynamic health and critical care environments.

This issue of Heart Failure Clinics, guest edited by Drs. Clyde W. Yancy and R. Kannan Mutharasan, will cover Process Improvement in Heart Failure. This issue is one of four issues selected each year by our series consulting editor, Dr. Eduardo Bossone. Topics discussed in this issue will include: Approaching Process Improvement, Identifying Heart Failure Patients, Predicting High-risk Patients and High-Risk Outcomes in Heart Failure, Selecting the Correct Target for Improvement in Heart Failure Care and Improving Adherence, Empowering Patients Living with Heart Failure with Social Media and Technology, Transitioning Heart Failure Patients to Outpatient Care, Innovating Outpatient Processes of Care and Anticipating Complex Care Algorithms, Addressing Co-morbidities in Heart Failure, Systematizing Heart Failure Population Health, Defragmenting Heart Failure Care, and Adapting to the Payment Landscape.

This issue of Medical Clinics of North America, Guest Edited by Deborah Wolbrette, MD is devoted to Cardiovascular Disease. Dr. Wolbrette has assembled a group of expert authors to review the following topics: Syncope due to Autonomic Dysfunction: Diagnosis and Management; 2013 Lipid Guidelines; 2014 Guideline for the Management of High Blood Pressure (JNC8); How to Follow Patients with Aortic and Mitral Valve Disease; The New Anticoagulants; Management of Atrial Fibrillation; Indications for Pacemakers, Implantable Defibrillators and Resynchronization Therapy; Current Status of Transcatheter Aortic Valve Replacement (TAVR); Chest Pain Evaluation: When to Order Troponin and Stress Tests/Cost Analysis; Indications for Cardiac MRI; Current Management of Heart Failure: When to Refer to Heart Failure Specialist and When is Hospice the Best Option; and Emerging Role of Digital Technology/Remote Monitoring in the Care of Cardiac Patients.

This issue of Heart Failure Clinics examines the critical role of team-based care in the management of patients with heart failure. Articles address Team-Based Care for Prevention, Patients Hospitalized with Heart Failure, Transitions of Care, Outpatients, Managing Cardiac Comorbidities, Managing Non-cardiac Conditions, Cardiac Rehabilitation and Exercise Training, External Telemonitoring, Ambulatory Hemodynamic Cardiac Device Monitoring, Advanced Heart Failure, and Palliative and End-of-Life Care.

This special issue of Heart Failure Clinics examines heart failure with a truly global perspective, exposing health inequities in the treatment of heart failure.

This issue of Heart Failure Clinics, guest edited by Dr. Francesco Antonini-Canterin, is dedicated to Clinical Heart Failure Scenarios: from Prevention to Overt Disease and Rehabilitation. This issue is one of four selected each year by series consulting editor Dr. Eduardo Bossone. This issue aims to provide a comprehensive overview over the broad spectrum of clinical scenarios of heart failure, starting from prevention in asymptomatic phase to acute and chronic congestive heart failure to modern rehabilitation.

This issue of Heart Failure Clinics, guest edited by Gina Price Lundberg and Laxmi S. Mehta, with consulting editor Eduardo Bossone, will focus on Heart Failure in Women. Topics include, but are not limited to, Gender Based Differences in Risk Factors for Development of Heart Failure, Imaging of Heart Failure , Heart Failure with Preserved Ejection Fraction in Women, Heart failure with Reduced Ejection Fraction in Women, Peripartum Cardiomyopathy, Stress Induced Cardiomyopathy, Atrial fibrillation and Heart Failure in Women, Breast Cancer and Heart Failure, Valvular Heart Disease and Heart Failure in Women, Congenital Heart Disease and Heart Failure, Advanced Therapies for Advanced Heart Failure in Women, CRT and ICDs in Women, Heart Transplants and Women, Sleep apnea and Heart Failure in Women, and Pulmonary Hypertension in Women.

This important issue of Medical Clinics provides essential updates in heart failure. The following topics are covered: epidemiology, pathophysiology, and general approach for heart failure; symptoms, signs, diagnostic studies, and prognostic significance of systolic versus diastolic heart failure; the appropriate use of biomarkers; oral versus intravenous diuretic therapy; guideline-based therapy including RAAS blockade, beta-blockade, and aldosterone antagonist, appropriate use of AICD and biventricular pacing; role of ventricular assist device; pathophysiological consideration and management approaches in acute decompensated heart failure; pathophysiology and current approaches to cardiorenal syndrome; heart failure with other comorbidities including diabetes, obesity, anemia, and cancer; heart failure and atrial fibrillation; and the role of disease management strategies in heart failure.

The presence of depression in patients with cardiovascular disease has been strongly associated with detrimental effects in terms of morbidity and mortality. This issue thoroughly examines the link between depression and heart disease, helping cardiologists to recognize depression in their patients so they can try to avert its serious consequences. The topics reviewed include screening for depression, the impact of depression on heart failure, beta blockers and depression, and ICDs and depression.

Over 5.7 million people in America carry a diagnosis of heart failure, the incidence of which approaches 1 in 100 people over the age of 65. The cost to society is estimated at $29 billion annually and over 1.1 million hospital admissions. For hospitalized heart failure patients, the 30-day readmission rate approaches 25%. As our population ages these numbers are expected to grow. This issue of Cardiology Clinics helps practitioners to manage patients at all ACC/AHA stages of heart failure and addresses key issues that include sudden cardiac death, arrhythmias, acute decompensated heart failure, and heart failure with preserved ejection fraction.