With the advent of World Heart Day on 29th September 2011, it is timely to consider emerging global and local challenges in heart disease. Chief among these is the increasing incidence and prevalence of heart failure throughout most nations on earth. In the developed world increasing recognition of cardiovascular risk factors with falling smoking rates and the widespread partial success in treating hypertension, together with improved secondary treatment of, and survival with, coronary heart disease has reduced early cardiovascular morbidity and mortality (although a rising tide of obesity and diabetes may yet reverse these trends). Many have therefore been spared from early severe cardiac injury or death but as years of partially treated hypertension, ischaemia and/or diabetes take their toll, patients incur heart failure at a later age. At age 40 years, life-time risk of heart failure is approximately 20% for both genders in western society1 with annual rates of new heart failure cases of 15, 32 and 65 per 1000 within age groups 65 to 74, 75 to 84 and over 85 years, respectively. In the developing world, increasing economic power and affluence are reflected in high smoking rates and rising rates of obesity, diabetes and hypertension with associated increases in early and late heart failure. In Singapore, which has enjoyed an unprecedented rate of development and increasing affluence over the last 50 years, age-adjusted heart failure admission rates rose 40% over 7 years from 1991 to 1998.2 Currently, heart failure is the most common cardiac cause for admission to Singapore Hospitals accounting for approximately 25% of such hospital stays.
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