Primary diseases need to be considered.

Neumann et al, worried by data from the Federal Statistical Office, report on "diagnoses, mortality, and costs" of heart failure, which, they say, "is currently one of the most common and most cost-intensive of the chronic diseases." The authors reflect generally on the costs associated with heart failure in Germany in 2006 and thinking about future trends. However, we wish to point out that heart failure is not a chronic disease but a clinical syndrome with characteristic symptoms that can have very diverse underlying disease causes. "Heart failure" should not be the general term used when writing about a chronic form of heart failure and if a concrete nosological classification of the presented heterogeneous statistical columns of figures is not possible. Acute and chronic left heart failure as well as acute and chronic right heart failure have different symptoms, although they all comprise classic symptoms. These indicate manifold changes and diseases of the right and left heart and the pericardium, which constitute the three groups of causes of heart failure: decompensated cardiac hypertrophy, myogenic heart failure, and pericardial changes. If "new concepts for prevention and treatment [of heart failure] will be needed in the near future" (1) because the population is ageing, the manifold etiologies of heart failure will have to be borne in mind. Non-smoking prevents chronic obstructive pulmonary disease (COPD) with right heart failure due to decompensated cor pulmonale. Blood pressure control and physical exercise prevent myocardial infarction and infarction related scarring as a result of coronary heart disease (2, 3). Fighting chronic alcoholism prevents some of the cardiomyopathies. These and many other diseases result in "heart failure," which is not obvious from the reported global statistic for this individual diagnosis (1). Considering the primary diseases for heart failure seems indicated when medical and economic aspects of the most common reason for hospitalization are being discussed.