Despite the trend for a decrease in fatality rates due to coronary heart disease, hospitalizations for acute myocardial infarction and its long term sequelae have remained high. In the United States, approximately 675,000 people were hos pitalized in 1990 with a first listed diagnosis of acute myocardial infarction. In-hospital mortality rates were 5% in patients less than 65 years of age and 17.6% in those greater than 65 years of age (26). Acute infarct mortality in the elderly has become particularly worrisome as evidenced by the 1990 Medicare mortality statistics showing death rates of 23% during the first 30 days postinfarct and 36% at the end of one year (61). In addition to the acute morbidity and mortality of sustaining a myocardial infarction, patients surviv ing the in hospital phase are in jeopardy of developing heart failure later on. A clinical history of a prior myocardial infarction increases the age adjusted risk of developing heart failure 7 and I8-fold for men and women, respectively (44). An update of the Framingham Heart Study found that coronary artery disease was increasingly prevalent as the cause of heart failure and accounted for 59% of new cases in men and 48% in women (Figure 1)(35, 36). Once the diagnosis of heart failure was made, the five-year survival rate was only