Heart failure (HF) is a clinical condition characterized by the failure of the heart to supply the rest of the body with the amount of blood necessary for the normal functioning of all its organs. As a result, patients with HF present suddenly or over days, weeks or months with a clinical picture characterized by shortness of breath (dyspnea), tiredness (asthenia) and swelling in the ankles and legs (edema) among other symptoms. As HF progresses, the risk of acute decompensation requiring urgent hospital admission increases and patients' quality of life deteriorates considerably.

In Spain, more than 3% of the adult population has HF, but this figure will increase in the coming years due to the aging of the population and the increase in the prevalence of cardiovascular diseases that lead to HF. In 2014, HF was the fourth leading cause of death in women and the sixth in men in our country. HF consumes enormous resources of our healthcare system: it is the leading cause of hospitalization in those over 65 years of age, gives rise to 3% of all hospital admissions, and accounts for 2.5% of the overall cost devoted to healthcare in Spain.

A challenge for society

The above data indicate that the CI constitutes a real challenge for our society. In view of this challenge there are three actions to be taken. First, optimize existing health care resources to reduce the incidence of new cases of HF and to improve the prognosis and quality of life of HF patients. Second, to investigate the mechanisms that produce heart failure in order to develop new HF treatments that are more effective and safer than those currently available. Third, to educate society to become aware of the magnitude of the problem and to participate in the search for solutions.

Reducing the incidence of HF requires the prevention of cardiovascular disease by controlling risk factors. Although notable progress has been made in recent decades in the control of arterial hypertension, hypercholesterolemia, and smoking, much remains to be done to control obesity and diabetes, which are increasingly associated with HF, especially HF with preserved ejection fraction. On the other hand, the development of HF units through the partnership of cardiology and primary care to systematize the diagnosis, treatment, and clinical follow-up of HF patients has been a major advance in improving HF care. Indeed, both observational and randomized programs of study carried out in Spain have shown that patients attended in these units have a lower issue number of visits to the emergency department and a lower issue number of readmissions (between 35% and 90%), greater therapeutic compliance, and even increased survival. In these very positive data we must take into account the contribution of the Education programs for patients with HF, which aim to train patients to "self-manage" their disease on a daily basis and in their usual environment.

research for the benefit of the patient

The research of HF currently has two priority areas of interest. First, to identify and characterize the mechanisms underlying the development of so-called HF with preserved ejection fraction. This is a HF whose prevalence is increasing, especially in elderly women, and whose treatment is not effective because of a lack of understanding of how heart failure occurs. Secondly, to accurately differentiate HF patients based on the analysis of multiple aspects related to their disease, but also to their medical biography and lifestyle, in order to establish personalized treatments that are more effective and safer for the patients themselves, as well as more sustainable for the healthcare system. Active research is being carried out in both areas in Spain through the research center Biomedica en network de las Enfermedades Cardiovasculares (CIBERCV), which depends on the high school de Salud Carlos III and in which 40 groups from research collaborate.

Society as a whole needs to assume the health, social and economic relevance of HF, and of cardiovascular diseases as a whole, just as it has assumed the relevance of cancer or neurodegenerative diseases. To degree scroll for examples that support this need, it is worth mentioning that the mortality rate of HF 5 years after diagnosis is as high as that of most types of cancer, and that the presence of HF significantly increases the risk of dementia and Alzheimer's disease in the elderly. Therefore, it is necessary that the administration and the media not only pay special attention to initiatives and news related to cancer and neurodegenerative diseases, but also to what has to do with HF. To this end, they will count on both health professionals and the associations of patients with HF that have been created in Spain in recent years.