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June 19, 1996

Cardiovascular Disease

Author Affiliations

University of Massachusetts Medical School, Worcester; The University of Arizona Health Sciences Center, Tucson

JAMA. 1996;275(23):1797-1798. doi:10.1001/jama.1996.03530470025015

The prevalence of chronic congestive heart failure continues to increase, even after adjusting for the aging of the US population. The increased prevalence is due, in part, to improved survival resulting from medical therapy. Stevenson et al1 examined the survival rates of 737 consecutive patients referred for heart transplantation who were discharged from the hospital and received medical therapy between January 1,1986, and December 31,1993. The 1-year mortality rate decreased from 33% before 1989 to 16% after 1990 (P<.001).1 A prospective, randomized trial of the effects of a nurse-directed, multidisciplinary intervention showed improved quality of life and reduced hospital use and medical costs for elderly patients with congestive heart failure during a 1-year follow-up.2 Pharmacological advances in the treatment of chronic heart failure with α-blockers3 and angiotensin-converting enzyme inhibitors4 have reduced the morbidity and mortality associated with this disorder.

The cost of thrombolytic therapy