http://repub.eur.nl/res/aut/21742/ List of Publications en http://repub.eur.nl/static-eur/img/logo.png http://repub.eur.nl http://repub.eur.nl/res/pub/18143/ 1997-05-21T00:00:00Z Heart failure can be defined as the pathophysiological state in which the pump function of the heart is insufficient to meet the metabolic demands of the body (Guyton, 1986; Ruggie, 1986). Thus, heart failure is a pathophysiological condition (rather than a disease per se), and can occur in the course of a number of cardiovascular diseases. In Western countries, hypertension and coronary artery disease or a combination of both account for the majority of cases of heart failure (McKee & Castelli, 1971; Kannel & Castelli, 1972; Eriksson & Svardsudd, 1989). Cardiomyopathies (of genetic, viral, toxic or idiopathic origin) and congenital heart disease are other important etiological factors (Eriksson & Svardsudd, 1989). In developing countries, acquired abnormalities of heart valves due to the sequelae of streptococcal infection are a common cause of heart failure (Killip, 1985). The incidence of heart failure gradually increases with age, resulting in an incidence rate of 1011000 per year for men, and 8/1000 per year for women (McKee & Castelli, 1971; Kannel & Castelli, 1972; Ho el at., 1993) in the over·65 age group.