Congestive Heart Failure Clinical Outcomes Study in a Private Community Medical Group

Louis A. Civitarese, DO, and Nicholas DeGregorio, MD,


J Am Board Fam Med. 1999;12(6) 

In This Article

Congestive Heart Failure: A High-Impact Diagnosis

In the United States the clinical syndrome of congestive heart failure affects 1% of the general population and 10% of the population older than 65 years.[4] In the group of patients older than 65 years, congestive heart failure was the most common admitting diagnosis. The medical literature has established improved symptom control, exercise tolerance, and survival for patients whose congestive heart failure and systolic dysfunction (left ventricular ejection fraction of 0.40 or less) are treated with angiotensin-converting enzyme (ACE) inhibitor therapy.[5,6,7] The SOLVD (Study of Left Ventricular Dysfunction) trial showed a reduction in hospitalizations from 36.6% to 25.8% for patients with mild to moderate congestive heart failure who were receiving ACE inhibitor therapy.[5,8]

In general, there has been considerable variation in the treatment of diseases by physicians.[9] Specifically, such variation has affected the care of patients with congestive heart failure.[5] Too often the distinction between systolic and diastolic dysfunction has not been determined in clinical practice, and studies have confirmed that ACE inhibitor therapy has been underutilized in treating systolic dysfunction.[10] Because congestive heart failure is common and effective treatment is available, yet underprescribed, we found congestive heart failure to be an excellent diagnosis for an outcomes study.