Heart failure: how can we prevent the epidemic?

Duncan J Campbell
Med J Aust 2003; 179 (8): 422-425.


  • Heart failure prevalence is increasing because of the ageing of the population and the longer survival of people experiencing myocardial infarction and heart failure. The lifetime risk of developing heart failure in Western countries is about 20%.

  • The increasing prevalence of overweight, obesity and diabetes is likely to accelerate heart failure incidence.

  • While there have been major advances in treating heart failure, a preventive approach promises greater benefit to a larger proportion of the community.

  • The medical strategy for heart failure prevention, based on calculation of individual risk, is focused on the minority of individuals who exceed an arbitrary risk threshold.

  • A public health strategy targeting the whole population offers a greater prospect of reducing the incidence of heart failure and other cardiovascular disease.

  • A multitiered approach, encompassing environmental determinants of lifestyle, legislation, and education about healthy lifestyles throughout life, in addition to aggressive control of risk factors in high-risk individuals, is likely to have the greatest impact.

Please login with your free MJA account to view this article in full

  • Duncan J Campbell

  • St Vincent's Institute of Medical Research and Department of Medicine, University of Melbourne, Fitzroy, VIC.



The author has received a Career Development Fellowship from the National Heart Foundation of Australia.

Competing interests:

None identified.

  • 1. Blyth FM, Lazarus R, Ross D, et al. Burden and outcomes of hospitalisation for congestive cardiac failure. Med J Aust 1997; 167: 67-70. <MJA full text>
  • 2. Lloyd-Jones DM, Larson MG, Leip EP, et al. Lifetime risk for developing congestive heart failure. The Framingham Heart Study. Circulation 2002; 106: 3068-3072.
  • 3. Australian Institute of Health and Welfare. Field B. Heart failure . . . what of the future? AIHW Bulletin No. 6. Canberra: AIHW, 2003. (AIHW Catalogue No. AUS-34.)
  • 4. Morgan S, Smith H, Simpson I, et al. Prevalence and clinical characteristics of left ventricular dysfunction among elderly patients in general practice setting: cross sectional survey. BMJ 1999; 318: 368-372.
  • 5. Krum H, Tonkin AM, Currie R, et al. Chronic heart failure in Australian general practice. The Cardiac Awareness Survey and Evaluation (CASE) Study. Med J Aust 2001; 174: 439-444. <MJA full text>
  • 6. Macdonald PS, O’Rourke MF. Cardiovascular ageing and heart failure. Med J Aust 1998; 169: 480-484.
  • 7. Yusuf S, Pitt B. A lifetime of prevention: the case of heart failure. Circulation 2002; 106: 2997-2998.
  • 8. Horowitz JD, Stewart S. Heart failure in older people: the epidemic we had to have. Med J Aust 2001; 174: 432-433. <MJA full text>
  • 9. Rose G. The strategy of preventive medicine. Oxford: Oxford University Press, 1992.
  • 10. Beaglehole R, Magnus P. The search for new risk factors for coronary heart disease: occupational therapy for epidemiologists? Int J Epidemiol 2002; 31: 1117-1122; author reply 1134-1135.
  • 11. Australian Institute of Health and Welfare. Heart, stroke and vascular diseases — Australian facts 2001. Canberra: AIHW, National Heart Foundation of Australia, National Stroke Foundation of Australia, 2001. (Cardiovascular Disease Series No. 14.)
  • 12. Cameron AJ, Welborn TA, Zimmet PZ, et al. Overweight and obesity in Australia: the 1999-2000 Australian Diabetes, Obesity and Lifestyle Study (AusDiab). Med J Aust 2003; 178: 427-432. <MJA full text>
  • 13. Massie BM. Obesity and heart failure — risk factor or mechanism? N Engl J Med 2002; 347: 358-359.
  • 14. Lakatta EG, Levy D. Arterial and cardiac aging: major shareholders in cardiovascular disease enterprises. Part I: aging arteries: a “set up” for vascular disease. Circulation 2003; 107: 139-146.
  • 15. Tonkin AM, Lim SS, Schirmer H. Cardiovascular risk factors: when should we treat? Med J Aust 2003; 178: 101-102. <MJA full text>
  • 16. National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand. Guidelines on the contemporary management of the patient with chronic heart failure in Australia. 2002. Available at: (accessed Aug 2003).
  • 17. Estimating coronary heart disease (CHD) risk using Framingham Heart Study prediction score sheets. Available at: (accessed Aug 2003).
  • 18. New Zealand Guidelines Group. Estimation of cardiovascular risk for men and women. Available at: (accessed Jul 2003).
  • 19. Vale MJ, Jelinek MV, Best JD, et al. How many patients with coronary heart disease are not achieving their risk-factor targets? Experience in Victoria 1996–1998 versus 1999–2000. Med J Aust 2002; 176: 211-215. <MJA full text>
  • 20. Wing LMH, Reid CM, Ryan P, et al. Second Australian National Blood Pressure Study (ANBP2) — comparative outcome trial of ACE inhibitor- and diuretic-based treatment of hypertension in the elderly: principal results. N Engl J Med 2003; 348: 583-592.
  • 21. Appel LJ, Moore TJ, Obarzanek E, et al. A clinical trial of the effects of dietary patterns on blood pressure. DASH Collaborative Research Group. N Engl J Med 1997; 336: 1117-1124.
  • 22. Sacks FM, Svetkey LP, Vollmer WM, et al. Effects on blood pressure of reduced dietary sodium and the Dietary Approaches to Stop Hypertension (DASH) diet. DASH-Sodium Collaborative Research Group. N Engl J Med 2001; 344: 3-10.
  • 23. Tuomilehto J, Lindstrom J, Eriksson JG, et al. Prevention of type 2 diabetes mellitus by changes in lifestyle among subjects with impaired glucose tolerance. N Engl J Med 2001; 344: 1343-1350.
  • 24. Diabetes Prevention Program Research Group. Reduction in the incidence of type 2 diabetes with lifestyle intervention or metformin. N Engl J Med 2002; 346: 393-403.
  • 25. Sdringola S, Nakagawa K, Nakagawa Y, et al. Combined intense lifestyle and pharmacologic lipid treatment further reduce coronary events and myocardial perfusion abnormalities compared with usual-care cholesterol-lowering drugs in coronary artery disease. J Am Coll Cardiol 2003; 41: 263-272.
  • 26. Berenson GS, Srinivasan SR, Bao W, et al. Association between multiple cardiovascular risk factors and atherosclerosis in children and young adults. N Engl J Med 1998; 338: 1650-1656.
  • 27. Magarey AM, Daniels LA, Boulton TJ, et al. Predicting obesity in early adulthood from childhood and parental obesity. Int J Obes Relat Metab Disord 2003; 27: 505-513.
  • 28. Egger G, Swinburn B. An “ecological” approach to the obesity pandemic. BMJ 1997; 315: 477-480.
  • 29. Pearson TA, Bazzarre TL, Daniels SR, et al. American Heart Association guide for improving cardiovascular health at the community level. A statement for public health practitioners, healthcare providers, and health policy makers from the American Heart Association Expert Panel on Population and Prevention Science. Circulation 2003; 107: 645-651.
  • 30. Dabkowski S. McDonald’s begins to see the light. The Age (Melbourne) 2003 Jun 30: 3.
  • 31. Harris MF, Mercer PJ. Reactive or preventive: the role of general practice in achieving a healthier Australia. Med J Aust 2001; 175: 92-93. <MJA full text>
  • 32. Steptoe A, Perkins-Porras L, McKay C, et al. Behavioural counselling to increase consumption of fruit and vegetables in low income adults: randomised trial. BMJ 2003; 326: 855-860.
  • 33. Vale MJ, Jelinek MV, Best JD, et al. Coaching patients with coronary heart disease to achieve the target cholesterol: a method to bridge the gap between evidence-based medicine and the “real world” — randomized controlled trial. J Clin Epidemiol 2002; 55: 245-252.
  • 34. McKinlay JB. More appropriate evaluation methods for community-level health interventions. Introduction to the special issue. Eval Rev 1996; 20: 237-243.
  • 35. Australian Research Alliance for Children and Youth. Available at: (accessed Jul 2003).


remove_circle_outline Delete Author
add_circle_outline Add Author

Do you have any competing interests to declare? *

I/we agree to assign copyright to the Medical Journal of Australia and agree to the Conditions of publication *
I/we agree to the Terms of use of the Medical Journal of Australia *
Email me when people comment on this article

Responses are now closed for this article.