Advances in the management of acute and chronic decompensated heart failure.

Congestive heart failure (CHF) is a pervasive and insidious disease that affects almost 5 million, mostly elderly, Americans. Significant therapeutic advances in the management of heart failure (HF) have resulted in striking decrements in mortality rates, but hospitalization use is ever increasing, now at over 1 million hospitalizations per year with a cost of > $15 billion--a cost that is largely borne by Medicare and Medicaid. One of the most historically challenging factors facing case managers who work with the CHF population is how to minimize treatment costs while enhancing clinical outcomes for those with this highly prevalent and clinically challenging chronic disease. To date the typical treatment of acute decompensation has been based in the hospital and woefully inadequate in promoting any long-term medical stability.