High-risk Stage B heart failure patients (4-5 structural abnormalities) had a significantly higher risk of HF readmission compared to low-risk patients (HR 4.42; 95% CI 2.43-8.06; p<0.001).
Observational (n=497)
No
Does subdividing Stage B heart failure by the number of structural abnormalities improve risk stratification for heart failure hospitalization?
Stratifying Stage B heart failure patients by the number of structural cardiac abnormalities significantly improves risk prediction for future heart failure hospitalization.
Effect estimate: HR 4.42 (95% CI 2.43-8.06)
p-value: p=<0.001
Abstract Background Preclinical heart failure (HF) encompasses Stage A and Stage B patients who are asymptomatic yet bear varying degrees of cardiovascular risk. Although the importance of early intervention is increasingly recognized, the prognostic implications of different risk strata within Stage B remain unclear. Traditional Stage B classification relies on the presence of any structural heart disease, but the severity and number of such abnormalities may confer different risks. Purpose We aimed to investigate whether subdividing Stage B by the number of structural abnormalities offers improved risk stratification for HF hospitalization in patients hospitalized on a cardiology ward. Methods A single-center retrospective observational study was conducted at our medical university from 2020 to 2023. Patients hospitalized on a cardiology ward who fulfilled Stage A or B criteria (no history of HF, no significant elevation in natriuretic peptides, and no loop diuretics prescribed at discharge) were included. Structural heart disease was defined as the presence of one or more of the following: (1) LVEF50%, (2) moderate-to-severe diastolic dysfunction, (3) LV hypertrophy, (4) LV dilation, (5) increased LAVI. Stage B was subdivided into Low-risk (1 abnormality), Intermediate-risk (2–3 abnormalities), and High-risk (4–5 abnormalities). The primary endpoint was HF readmission. Kaplan-Meier analysis and Cox proportional hazards models were utilized to compare the groups. Results Out of 3,220 hospitalized patients, 497 met the inclusion criteria: Stage A (n=40) and Stage B (n=457), with Stage B further categorized into Low-risk (n=169), Intermediate-risk (n=238), and High-risk (n=50). Over a median follow-up of 700 days, the incidence of HF hospitalization differed significantly among the four groups (p0.001). Within Stage B, the hazard ratios (HR) for HF hospitalization, compared with the Low-risk group, were 2.48 (95% CI 1.58–3.77, p0.001) for the Intermediate-risk group and 4.42 (95% CI 2.43–8.06, p0.001) for the High-risk group. Multivariable analysis identified left ventricular dilation (HR 3.03, p=0.002) and diastolic dysfunction (HR 3.02, p=0.003) as significant predictors of HF readmission. Conclusion(s) Stage B patients can be further stratified into three risk groups based on the number of structural cardiac abnormalities, with higher risk groups demonstrating a markedly increased incidence of HF readmission. In particular, LV dilation and diastolic dysfunction were powerful predictors of HF hospitalization. These findings underscore the need for careful monitoring of high-risk Stage B patients and may support targeted interventions to prevent the transition from preclinical to overt HF.
Nokubo et al. (Sat,) conducted a observational in Preclinical heart failure (Stage A and Stage B) (n=497). High-risk Stage B (4-5 structural abnormalities) vs. Low-risk Stage B (1 structural abnormality) was evaluated on Heart failure readmission (HR 4.42, 95% CI 2.43-8.06, p=<0.001). High-risk Stage B heart failure patients (4-5 structural abnormalities) had a significantly higher risk of HF readmission compared to low-risk patients (HR 4.42; 95% CI 2.43-8.06; p<0.001).