Who Would Be Branded With Failure?

Lynne Warner Stevenson, MD


Circulation. 2017;136(15):1359-1361. 

In This Article

What is Their Condition?

The HF clinical syndrome is the consequence, not a cause, of the disease. Many causes have been elucidated since the early era, including appreciation of the genetic contribution to nonischemic cardiomyopathy and the complex aspects of remodeling, hibernation, and mitral regurgitation in HF with coronary artery disease. Some new causes have emerged among the effective agents for cancer and rheumatologic disease. The thrust of treatments toward HF prevention now merits a different term for the target condition.

Some languages use the term "insufficiency," which offers more hope of adaptation than the term "failure" but still aims distal to prevention. "Cardiomyopathy" is a term once limited strictly to myocyte disease without structural heart disease, but common use now includes ischemic cardiomyopathy and valvular cardiomyopathy and does not require symptoms. Many of our effective therapies improve the function and environment of the abnormal myocyte, rendering "cardiomyopathy" a plausible common target. It has the advantage of already being in common use and descriptive of many points in the journey before the typical HF syndrome.

Whether the underlying conditions are summarized as cardiomyopathy or another term, the term "heart failure" remains appropriate to describe transitions. The first hospitalization with decompensated HF clearly identifies an event warranting reassessment, and refractory HF is a transition toward transplantation, mechanical circulatory support, or ascending levels of palliation.