Heart failure (HF) is and will continue to be a major clinical problem in the United States, with an estimated prevalence of 6.5 million that is projected to increase to 8 million by 2030. Persons with HF account for about 1 million acute care hospitalizations, 2 million outpatient visits, and at least 500 000 emergency department (ED) evaluations annually (1). Patients with HF typically are older than 55 years and fragile and have multiple comorbid conditions, such as hypertension, coronary artery disease, atrial fibrillation, diabetes, and chronic renal insufficiency. Only about half have systolic dysfunction (ejection fraction <0.40), for which treatment guidelines for long-term care are well-established. The remainder have similar symptoms but normal or near-normal systolic function. Best practice for long-term care of those with preserved systolic function has been elusive (2, 3). Regardless of the underlying mechanism of HF, many of these patients have minimal functional reserve to cope with the various life stresses they encounter and spin out of control into acute heart failure (AHF).

在美国，心力衰竭（HF）一直并将继续是一个主要的临床问题，估计患病率为650万，预计到2030年将增加至800万。HF患者约占100万人，每年有200万门诊就诊，并且每年至少进行50万急诊（ED）评估（1）。HF患者通常年龄超过55岁且易碎，并患有多种合并症，例如高血压，冠状动脉疾病，心房颤动，糖尿病和慢性肾功能不全。仅有约一半的患者患有收缩功能障碍（射血分数<0.40），为此已制定了长期护理的治疗指南。其余患者具有相似的症状，但收缩功能正常或接近正常。长期护理那些具有收缩功能的患者的最佳实践是难以捉摸的（2、3）。无论HF的潜在机制如何，其中许多患者的功能储备都很少，无法应对他们所遇到的各种生活压力，并失去控制，演变成急性心力衰竭（AHF）。