Prevalence of asymptomatic heart failure in Italian elderly subjects living in Rome communities: insight from PREVASC II study

Aims Increasing evidence for a latent, preclinical phase of cardiac pathology prior to the development of symptomatic heart failure (HF) has fueled interest in developing a screening program for early disease detection and intervention. This study explores asymptomatic HF prevalence in elderly subjects living in a series of communities (parishes and senior centers) belonging to a populous (259.000 inhabitants) in the VI district of the municipality of Rome. Methods We conducted an observational, cross-sectional study in 7 parishes and senior centers in Rome. Subjects aged ≥65y, asymptomatic, and without a previous history of HF were enrolled by voluntary participation. Asymptomatic HF was identified using the ACC/AHA definition for stage B HF. All participants underwent a comprehensive evaluation including a cardiological examination, an electrocardiogram and an echocardiogram according to ESC guideline, focusing on evaluation of systolic left ventricular ejection fraction (EF), diastolic function (E/e’) and left atrial size. Results We enrolled 2600 subjects, with a mean age of 73 ± 6 years and a balanced gender distribution (53.1% female). The prevalence of any degree of HF (EF <50%) was observed in 241 subjetcs (9.27%), HFmrEF (>40≤49) in 220 (8.46%) and HFrEF (EF≤40) in 21 subjects (0.81%). Moreover, the prevalence of advanced HFrEF (EF ≤30%) was observed in 3 subjects (0.11%). The isolated diastolic dysfunction (E/e’>8) was detected in 703 subjects (27.0%), and enlarged atrial size (>21 cm2) was observed in 619 subjects (23.8%). Conclusions the incidence of asymptomatic HF was not negligible in elderly subjects living in Rome communities. In our study population the HFmrEF was the prevalent phenotype. Moreover, the isolated diastolic dysfunction was found in a quarter of asymtomatic subjects. A large beneficial effect may be expected adopting optimal medical therapy recommended by current ESC guidelines. Further research is required to investigate whether early detection and intervention can slow or stop the progression from asymptomatic to symptomatic HF.