The epidemiology of heart failure is a truly confusing subject. One problem is that the definition of heart failure varies so much across the many studies. One beacon in the fog is the Framingham study, which began with a definition of heart failure in 1948 and has stuck to it ever since. The Framingham criteria, derived entirely from the clinical history and examination, avoid the common trap of equating “heart failure” with reduced left systolic ejection fraction. They are also used in the Rochester Epidemiology Project, which has accumulated over 20 years of data from a much larger population in Olmsted County, Minnesota. (

). Judged by clinical criteria, the incidence of heart failure has remained almost constant amongst men in Framingham (

) and among both sexes in Olmsted County. Survival in heart failure has improved, suggesting that evidence-based medicine actually works. The improvement is much greater in those we have evidence for—the younger and male end of …