Background: Knowledge on clinical characteristics and prognosis of patients with heart failure originates from studies of selected populations in clinical trials or from epidemiological observations. Reports on the large numbers of patients with heart failure treated in community hospitals are sparse. Objecti¨e: Are there differences in patient characteristics and heart Ž . Ž . failure management between a metropolitan heart center HC and a rural community hospital RCH ? Patients and methods:Ž . Retrospective analysis of medical charts from all patients admitted for heart failure ICD 428.x, NYHA II᎐IV, EF -45% between May 1997 and April 1998 and discharged alive from a rural community hospital. A similar, but prospective registry was available at the HC. Follow-up information was obtained by request at registration authorities. Results: Patient groups Ž . Ž . comprised 120 in RCH and 146 in HC. Mean age was 75 " 11 and 66 " 11 years, respectively P-0.001 ; 48% RCH vs. 74% Ž . Ž . Ž . Ž . HC of patients were male P-0.001 . On admission the proportion of functional class IV was 69% RCH vs. 17% HC Ž . Ž . Ž . Ž . Ž . P-0.001 . At discharge, the rate of ACE-inhibitors was 74% RCH vs. 98% HC ; 11% RCH vs. 43% HC of patients received ␤-blocker therapy. Ninety-six percent of patients in HC underwent and 22% in RCH had undergone invasive Ž diagnostics. One-year mortality rate of patients discharged alive was 26% in RCH and 19% in HC Ps n.s. after adjustment . for age and gender . Conclusion: Heart failure management according to current guidelines, using ␤-blockers and ACE inhibitors, and invasive cardiac examination was significantly less performed in the rural community hospital than in the metropolitan heart center. Therefore, strategies to improve heart failure management according to guidelines are urgently needed. ᮊ

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Radiation-induced effects may damage various cardiac structures chronically and cause heart valve dysfunction as well as occlusive lesions of coronary and other arteries exposed to radiation. A 72-year-old woman with a history of radiation treatment after breast cancer was admitted 25 years later with symptoms of tachycardia and acute dyspnea. We found valvular thickening, medium to severe valvular dysfunction and high grade occlusive coronary artery disease in proximal portions. The left subclavian artery also was affected. Surgical treatment was required immediately. Long-term follow-up cardiac evaluation even in asymptomatic patients is mandatory to uncover cardiac injuries by radiation. To lower the risk and maximize the benefit, early intervention by valvular replacement and myocardial revascularization is indicated. Restrictive myopathy and chronic pericarditis increase risk and have to be clarified. Diagnosis in these radiation exposed patients can be made by typical findings. Echocardiography is of eminent relevancy.