Detection of stage B heart failure in a nationwide, decentralized systematic program

Background Heart failure (HF) is a growing public health priority, with more than 11 million U.S. adults projected to be affected by 2050 [1,2]. Echocardiography is foundational to the diagnosis of Stage B HF, enabling detection of asymptomatic structural and functional abnormalities that precede overt disease and allow early preventive intervention [3]. However, the burden and phenotypic spectrum of Stage B HF identified through systematic evaluation in real-world Medicare populations are limited. Purpose To characterize the identification of Stage B HF using an echocardiography-centered, risk-based evaluation strategy within a nationwide, value-based primary care population and to describe the distribution of underlying cardiac phenotypes. Methods A large-scale, nationwide, decentralized cardiology program was implemented to evaluate Medicare beneficiaries aged ≥60 years with at least one Stage B HF risk factor were identified through electronic health records. Those without known HF or an echocardiogram in the prior year underwent systematic biomarker testing, with elevated results prompting referral for subsequent echocardiography. Prespecified echocardiographic criteria were used to identify Stage B HF, with abnormal findings triggering structured cardiology e-consults focused on HF risk-factor evaluation and management. Results Between April 2022 and December 2025, 80,298 screening echocardiograms were obtained among eligible beneficiaries (mean age 72.5 years; 61.3% female). Findings consistent with Stage B HF were identified in 53,133 participants (66.2%). The most common abnormalities were left ventricular hypertrophy (33.6%) and diastolic dysfunction (29.8%). Systolic left ventricular dysfunction and significant valvular heart disease were in 2.3% and 5.5% participants, respectively (Table). All participants with Stage B HF received structured clinical support through cardiology e-consults focused on HF risk-factor preventive management and optimization. Conclusions Within a value-based primary care program serving a high-risk Medicare population, an echocardiography-centered workflow identified Stage B HF in approximately two-thirds of beneficiaries. These findings highlight the heterogeneity of preclinical HF phenotypes and underscore opportunities for earlier intervention to mitigate progression to symptomatic HF.