Among stage B heart failure individuals, impaired cardiorespiratory fitness was associated with a 2.75-fold higher risk of incident heart failure compared to those with preserved fitness over 20 years.
Observational (n=1,683)
Yes
Does incorporating estimated cardiorespiratory fitness into heart failure staging improve the prediction of incident heart failure in community-dwelling individuals?
Incorporating estimated cardiorespiratory fitness into existing heart failure staging criteria significantly improves risk stratification for incident heart failure, particularly identifying high-risk individuals among those with stage B heart failure.
Effect estimate: HR 2.75 for stage B with impaired CRF vs stage B with preserved CRF (95% CI 1.50–5.07)
p-value: p=0.001
Background Heart failure (HF) progresses through stages, from risk factors (stage A) to structural abnormalities, or elevated biomarkers (stage B), to clinical HF (stage C) as depicted by the American Heart Association/American College of Cardiology/Heart Failure Society of America guidelines. Most individuals in stage B never develop clinical HF, highlighting the need for refined preclinical phenotyping. We hypothesized that refined HF stages incorporating cardiorespiratory fitness (CRF) would be differentially associated with HF risk. Methods This observational cohort study investigated FHS (Framingham Heart Study) participants who completed submaximal exercise testing (stage 2 of the Bruce protocol). CRF (peak oxygen uptake) was estimated on the basis of stage 2 heart rate, weight, age, sex, treadmill grade, and velocity. We evaluated the association of HF substages (categorized by CRF above versus below the sex‐specific median) with incident HF using Cox models adjusted for age and sex. Results Among 1683 individuals (55% women, age 58±8 years, estimated CRF 35.4±3.2 mL/kg per min in women and 40.1±4.2 mL/kg per min in men) 522 individuals (31%) were classified as no HF risk factors (“healthy”; stage H), 693 (41%) as stage A, and 468 (28%) as stage B at baseline. Over median follow‐up of 20 years, 99 HF events occurred. Stage B participants with low CRF had a >2.5‐fold higher HF risk (hazard ratio HR, 2.75 95% CI, 1.50–5.07; P =0.001). Among stage B participants, every 1‐SD increase in CRF was associated with lower HF risk (HR, 0.57 95% CI, 0.43–0.76; P =0.0001). Conclusions Incorporating CRF into HF staging criteria may improve risk assessment and facilitate precision targeting of preventive therapies, especially among individuals classified as stage B.
Davis et al. (Thu,) conducted a observational in Community-dwelling middle-aged adults (mean age 58±8 years, 55% women) without prevalent heart failure undergoing submaximal exercise testing (n=1,683). Refined heart failure staging incorporating cardiorespiratory fitness (CRF) assessment using estimated peak VO2 from submaximal exercise testing vs. Traditional HF staging without CRF incorporation was evaluated on Incident heart failure according to Framingham Heart Study criteria (HR 2.75 for stage B with impaired CRF vs stage B with preserved CRF, 95% CI 1.50–5.07, p=0.001). Among stage B heart failure individuals, impaired cardiorespiratory fitness was associated with a 2.75-fold higher risk of incident heart failure compared to those with preserved fitness over 20 years.