T he treatment of chronic heart failure (HF) has yielded significant improvements in outcomes for many patients over the last 30 years, although the majority of these advances have been in the therapy for heart failure with reduced ejection (HFrEF) (1,2). This momentum continues; the novel agent sacubitril/valsartan reduced cardiovascular mortality another 16% when compared with traditional optimal medical therapy for HFrEF in the landmark PARADIGM-HF (Prospective Comparison of ARNI [Angiotensin Receptor–Neprilysin Inhibitor] with ACEI [Angiotensin-Converting–Enzyme Inhibitor] to Determine Impact on Global Mortality and Morbidity in Heart Failure) trial (3). However, HF is ultimately fatal; even in that contemporary clinical trial of optimally-managed outpatients, 2-year mortality was 20% (2). The inpatient HF story is worse: in the EVEREST (Efficacy of Vasopressin Antagonism in Heart Failure Outcome Study With Tolvaptan) trial of tolvaptan for acute decompensated HF (ADHF), all-cause mortality was just over 25% at a median follow-up of 10 months (4). However, as remarkable as these data are, where do we stand in the world of routine practice across the spectrum of HF?

中文翻译：

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急性心力衰竭的长期结果

在过去的 30 年中，慢性心力衰竭 (HF) 的治疗已显着改善了许多患者的预后，尽管这些进展中的大部分是射血减少的心力衰竭 (HFrEF) 的治疗 (1,2) . 这种势头还在继续；与具有里程碑意义的 PARADIGM-HF（ARNI [血管紧张素受体-脑啡肽酶抑制剂] 与 ACEI [血管紧张素转换酶抑制剂]确定对心力衰竭全球死亡率和发病率的影响）试验 (3)。然而，HF最终是致命的。即使在当代最佳管理门诊患者的临床试验中，2 年死亡率也为 20% (2)。住院 HF 的故事更糟：在托伐普坦治疗急性失代偿性心力衰竭 (ADHF) 的 EVEREST（加压素拮抗剂在心力衰竭结局研究中的疗效）试验中，中位随访 10 个月时，全因死亡率刚刚超过 25% (4)。然而，尽管这些数据非常引人注目，但我们在整个 HF 频谱的常规实践世界中处于什么位置？