Key result
PREVENT-HF equation accurately predicts 10-year incident HFpEF and HFrEF with c-statistics near ~0.80.
Why the study?
Does the PREVENT-HF risk equation accurately predict incident HFpEF and HFrEF in community-based cohorts?
Cohort (n=22,061)
Yes
Does the PREVENT-HF risk equation accurately predict incident HFpEF and HFrEF in community-based cohorts?
Effect estimate: c-statistic 0.81 for HFpEF, 0.78 for HFrEF (95% CI 0.80-0.83 for HFpEF, 0.76-0.80 for HFrEF)
p-value: p=<0.001
The PREVENT-HF risk equation demonstrates strong and similar discrimination for predicting both incident HFpEF and HFrEF at 10 years in community-based cohorts.
Background: The recent PREVENT-HF risk equations were developed to estimate 10-year risk of overall HF. While HF with preserved vs reduced ejection fraction (HFpEF; HFrEF) have common risk factors, distinct differences in risk conferred by older age, obesity, and coronary artery disease are known. In this context, we sought to evaluate the performance of PREVENT-HF equations relative to HFpEF vs HFrEF. Methods: We examined participants from 4 pooled community-based cohort studies: the Multi-Ethnic Study of Atherosclerosis (MESA), Framingham Heart Study (FHS) offspring exam 6, Cardiovascular Heart Study (CHS), and Prevention of Renal and Vascular End-stage Disease (PREVEND) study. We excluded those with ages <30 and >79 years, prevalent HF, prevalent CVD, and missing key clinical information. We compared the performance of the PREVENT-HF equation in predicting incident HFpEF vs HFrEF at 10 years using Uno’s C-statistics and area under receiver operating characteristic (AUROC). Results: Among 22,061 participants (age 59 ± 14 years, 54% women, BMI 27 ± 5 kg/m 2 ), 322 developed HFpEF and 464 HFrEF during a median follow-up of 10 years. The PREVENT-HF risk equation performed well for both HFpEF (c-statistic 0.81, 95% CI 0.80-0.83) and HFrEF (c-statistic 0.78 (95% CI 0.76-0.80), with similar improvement compared with age and sex alone (HFpEF: c-statistic 0.78, 95% CI 0.76-0.80; HFrEF: c-statistic 0.75, 95% CI 0.73-0.76, P<0.001 for delta for both). The AUROC remained stable across 1-10 years demonstrating consistently strong discrimination for both HFpEF and HFrEF. Time-dependent AUCs were generally higher for HFpEF compared with HFrEF, indicating slightly better discrimination for HFpEF across all time horizons ( Figure ). Conclusions: Our findings demonstrate overall similar performance of the PREVENT-HF risk model with respect to HFpEF and HFrEF. Future studies on subtype-specific risk models may improve upon current risk prediction tools for overall HF.
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Parekh et al. (2026) conducted a cohort in Heart failure (HFpEF and HFrEF) (n=22,061). PREVENT-HF risk equations vs. Age and sex alone was evaluated on Incident HFpEF and HFrEF at 10 years (c-statistic 0.81 for HFpEF, 0.78 for HFrEF, 95% CI 0.80-0.83 for HFpEF, 0.76-0.80 for HFrEF, p=<0.001). The PREVENT-HF risk equation demonstrated strong discrimination for predicting 10-year incident HFpEF (c-statistic 0.81; 95% CI 0.80-0.83) and HFrEF (c-statistic 0.78; 95% CI 0.76-0.80).
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