Relapse of congestive heart failure (CHF) frequently occurs and has serious consequences in terms of morbidity, mortality, and health care expenditure. Many studies have investigated the aetiological and prognostic factors of CHF, but there are only limited data on the role of precipitating factors that trigger relapse of CHF. Knowledge of potential precipitating factors may help to optimise treatment and provide guidance for patients with CHF. The literature was reviewed to identify factors that may influence haemodynamic homeostasis in CHF. Precipitating factors that may oVer opportunities for preventing relapse of CHF were selected. Potential precipitating factors are discussed in relation to the pathophysiology of CHF: alcohol, smoking, psychological stress, uncontrolled hypertension, cardiac arrhythmias, myocardial ischaemia, poor treatment compliance, and inappropriate medical treatment. Poor treatment compliance in particular is frequently encountered in patients with CHF. Furthermore, studies of medical treatment under everyday circumstances indicate that some aspects of the management of CHF can be improved. In conclusion, the identification of precipitating factors for relapse of CHF may strongly contribute to optimal treatment. Improvement of treatment compliance and optimalisation of medical treatment may oVer important possibilities to clinicians to reduce the number of relapses in patients with CHF. (Heart 1998;80:432-436) Keywords: congestive heart failure; precipitating factors; prevention There is increasing interest in congestive heart failure (CHF) from both clinicians and researchers. The prevalence of CHF continues to increase despite advances in the treatment of various risk factors for this disease, such as hypertension and coronary artery disease.
1This increase is the result of several medical and demographic developments: an aging population, decreasing mortality of patients with acute myocardial infarction, and improved treatment of patients with angina pectoris and hypertension.2 In addition, survival in patients with CHF has improved since the introduction of angiotensin converting enzyme (ACE) inhibitors.CHF is clinically characterised by periods of remission and exacerbation. Readmission rates of up to 25% within six months after a previous hospital discharge for CHF have been reported in patients older than 65 years.3 4 Relapse of CHF in patients with previously stable compensated heart failure may be caused by deteriorating ventricular function, but several precipitating factors have been suggested. Some precipitating factors can be regarded as potentially preventable. Research on precipitating factors leading to relapses of CHF, however, is scarce.5 6 Nevertheless, timely identification of potential precipitating factors may oVer an important advantage in eVorts to reduce morbidity and the number of hospital admissions attributed to the syndrome of CHF.We conducted a search of the MEDLINE database from 1966 to December 1997 and used lateral references to review the li...