Will Evaluation of Cardiorespiratory Fitness Improve Risk Stratification of Patients With Stage B Heart Failure?

Heart Association, and the Heart Failure Society of America updated the 2013 classification and definition of stages of heart failure (HF). 1 The major addition was the addition of biomarkers (natriuretic peptides and hs-troponin) to abnormal left ventricular and left atrial imaging findings in patients with Stage B, "pre-HF."These patients already had a baseline risk of developing HF (Stage A) due to hypertension, atherosclerotic heart disease, diabetes, obesity, and genetic and other potential risks.In a cohort of 11 618 patients from the MESA (Multi-Ethnic Study of Atherosclerosis), the CHS (Cardiovascular Health Study), and the FHS (Framingham Heart Study), the updated criteria increased the number of patients from 15.9% without the addition of biomarkers to 43.2% for Stage B HF. 2 Despite this increase in the number of patients with Stage B HF, there were no significant increases in the incidence of new onset HF, cardiovascular mortality, and all-cause mortality when compared with older criteria.In this analysis of 3 different patient groups, the majority of patients >75 years of age, 48% of women, and 38% of men were diagnosed with Stage B HF, yet only a relatively small number develop clinical HF (21.9 case per 1000 patient-years).With several therapeutic advances in the treatment and prevention of HF, including the use of SGLT2 (sodium glucose transporter 2) inhibitors, 3,4 GLP-1 (glucagon-like peptide-1) receptor agonists, 3 finerenone, 5 and angiotensin-converting