Key result
In a population-based cohort, 42% and 17% of subjects had heart failure precursor stages A and B, respectively, with 31% of stage B subjects lacking established stage A risk factors.
Why the study?
Heart failure prevention depends on early identification and control of risk factors, prompting investigation into the frequency and characteristics of individuals at risk of heart failure in the general population.
Cross-Sectional (n=4,965)
No
A significant proportion of individuals with asymptomatic cardiac dysfunction (Stage B heart failure) lack established risk factors (Stage A), suggesting they may be missed by conventional primary prevention strategies.
Conventional risk screening may miss stage B HF in ~30% of cases; leaves open whether broader detection criteria improve outcomes.
AIMS: Prevention of heart failure relies on the early identification and control of risk factors. We aimed to identify the frequency and characteristics of individuals at risk of heart failure in the general population. METHODS AND RESULTS: We report cross-sectional data from the prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of residents of Würzburg, Germany. Sampling was stratified 1:1 for sex and 10:27:27:27:10 for age groups of 30-39/40-49/50-59/60-69/70-79 years. Heart failure precursor stages were defined according to American College of Cardiology/American Heart Association: stage A (risk factors for heart failure), stage B (asymptomatic cardiac dysfunction). The main results were internally validated in the second half of the participants. The derivation sample comprised 2473 participants (51% women) with a distribution of 10%/28%/25%/27%/10% in respective age groups. Stages A and B were prevalent in 42% and 17% of subjects, respectively. Of stage B subjects, 31% had no risk factor qualifying for stage A (group 'B-not-A'). Compared to individuals in stage B with A criteria, B-not-A were younger, more often women, and had left ventricular dilation as the predominant B qualifying criterion (all P < 0.001). These results were confirmed in the validation sample (n = 2492). CONCLUSION: We identified a hitherto undescribed group of asymptomatic individuals with cardiac dysfunction predisposing to heart failure, who lacked established heart failure risk factors and therefore would have been missed by conventional primary prevention. Further studies need to replicate this finding in independent cohorts and characterise their genetic and -omic profile and the inception of clinically overt heart failure in subjects of group B-not-A.
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Morbach et al. (2020) conducted a cross-sectional in Precursor stages of heart failure (n=4,965). Precursor stages of heart failure was evaluated on Prevalence of heart failure precursor stages A and B. In a population-based cohort, 42% and 17% of subjects had heart failure precursor stages A and B, respectively, with 31% of stage B subjects lacking established stage A risk factors.
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