Background Heart failure is an epid

Background Heart failure is an epidemic that affects approximately 5 million Americans with an incidence of approximately 500,000 cases per year. This syndrome is characterized by ventricular dysfunction, exercise intolerance, reduced quality of life (QoL), and markedly shortened life expectancy. Heart failure is the terminal stage of cardiac disease with a 5-year survival of 25% in men and 38% in women. The mortality rates over the last four decades have shown no marked improvements and the median survival time after the onset of heart failure is 1.7 years in men and 3.2 years in women, with 33% dying in the first year approximating that of many cancers. Patients with heart failure are disadvantaged compared to patients with other terminal diseases in that they are often less likely to understand their illness, have access to supportive care, and have the opportunity to plan for death and dying.