Heart failure has become the leading public health challenge faced by cardiovascular medicine today. In spite of medical and surgical advances, total mortality continues to rise, particularly in the older population.<sup>25Haldeman G.A., Rashidee A., Horswell R. Changes in mortality from heart failure—United States, 1980–1995 MMWR Morb Mortal Wkly Rep 1998 ;  47 : 633-638

Cliccare qui per andare alla sezione Riferimenti</sup> Although likely responsible for approximately 12 million outpatient visits per year,<sup>37O'Connell J.B., Bristow M.R. Economic impact of heart failure in the United States: Time for a different approach J Heart Lung Transplant 1994 ;  13 : S104-S112

Cliccare qui per andare alla sezione Riferimenti</sup> a more concerning fact is that heart failure now constitutes the most common hospital discharge diagnosis for patients older than age 65.<sup>41Rich M.W. Epidemiology, pathophysiology and etiology of congestive heart failure in older adults J Am Geriatr Soc 1997 ;  45 : 968-974

Cliccare qui per andare alla sezione Riferimenti</sup> This finding reflects the high incidence of the underlying condition—ventricular dysfunction—and more importantly the frequency with which the disease results in clinical decompensation requiring inpatient medical care. As a result, critical care specialists likely will be exposed in the future to an increasing volume of patients with various forms and degrees of heart failure exacerbation. This article focuses primarily on the approach to patients presenting with an acute decompensation of established ventricular dysfunction, because the management of cardiogenic shock and acute myocardial infarction are addressed elsewhere in this issue.