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Background: The AHA/ACC classification system for heart failure (HF) consists of four stages to better characterize the progression of the disease. Studies have demonstrated a high risk of progression from preclinical HF (Stage A/B) to clinical HF (Stage C/D). The aim of this study was to evaluate the incidence of preclinical HF in a community population.
Methods: A retrospective review of the Olmsted County Heart Function Study cohort, a population-based random sample of 2042 Olmsted County, MN residents aged ≥ 45 years. A subgroup of normal community individuals was identified as having no HF risk factors with normal ventricular structure and function who returned for two visits, four years apart. After visit two, we compared individuals that developed preclinical HF to those that did not. Stage B was delineated into two groups, those with preserved ejection fraction (pEF) (≥ 50%) and those with reduced (rEF) (< 50%).
Results: A total of 399 healthy subjects were identified. After four years, 213 (53%) developed preclinical HF (13.3 cases per 100 person-years of follow-up). Of those that progressed, 87 (41%) developed Stage A, 119 (56%) Stage B pEF, and 7 (3%) Stage B rEF. Individuals that developed preclinical HF were older (p=0.004), more likely to be male (p=0.02), had higher body mass index (p<.001), and higher total cholesterol (p<.001). No differences were seen for creatinine, triglycerides, insulin, glucose, NT-proBNP, aldosterone, ANP, or high-sensitivity troponin (all within normal range). Higher left ventricular (LV) end-diastolic volume (p=0.03), LV end-systolic volume (p=0.04), and LV mass index (p=0.01) were seen in those that progressed. After an additional 8 year follow-up period, there was a trend towards higher incidence of cardiac events (myocardial infarction, hospitalized heart failure, stroke and atrial fibrillation) in those that progressed to Stage A or B HF (HR: 2.04 95%CI (0.99-4.24), p=0.05).
Conclusions: Among healthy adults ≥ 45 years in the community, there is a high incidence of preclinical HF (Stage A/B). Further studies are needed to evaluate individuals at risk and determine if aggressive management of risk factors can delay the progression to clinical heart failure.
Poster Hall, Hall C
Friday, March 17, 2017, 10:00 a.m.-10:45 a.m.
Session Title: Making Progress in Understanding Heart Failure
Abstract Category: 13. Heart Failure and Cardiomyopathies: Clinical
Presentation Number: 1123-270
- 2017 American College of Cardiology Foundation