Community Screening for Nonischemic Cardiomyopathy in Asymptomatic Subjects ≥65 Years With Stage B Heart Failure

Area of Science:

• Cardiology
• Preventive Medicine
• Biostatistics

Background:

• Early identification of individuals at risk for heart failure (HF) is crucial for effective screening and prevention strategies.
• Existing risk scores may not fully capture the complexity of HF development in asymptomatic older adults.
• Integrating clinical, functional, and electrocardiographic data can potentially improve risk stratification.

Purpose of the Study:

• To develop and validate an effective screening process for identifying individuals at high risk of developing heart failure (HF).
• To integrate clinical risk scores, functional capacity (6-minute walk test), and electrocardiogram (ECG) findings for improved HF risk prediction.
• To compare the effectiveness of the Atherosclerosis Risk in Communities (ARIC) score against the Framingham HF score.

Main Methods:

• A cohort of asymptomatic subjects aged 65 years and older with at least one HF risk factor was recruited.
• Participants underwent clinical evaluation, HF risk assessment (Framingham HF score, ARIC score), ECG, echocardiography, and a 6-minute walk (6 MW) test.
• A classification and regression tree (CART) analysis was used to integrate ARIC score and 6 MW data for risk stratification, with abnormal ECG further refining intermediate-risk groups.

Main Results:

• The ARIC score demonstrated higher predictive accuracy for incident HF than the Framingham HF score (AUC 0.65 vs 0.53, p=0.01).
• CART analysis identified ARIC score (>9.5%) and 6 MW (<501 m) as key predictors, defining low, intermediate, and high-risk groups.
• The high-risk group identified by the combined strategy showed significantly more echocardiographic signs of cardiac dysfunction and a higher incidence of new HF (20% vs 10%, p=0.003).

Conclusions:

• A combined clinical risk assessment (ARIC score) and electrocardiographic (ECG) strategy effectively identifies a high-risk population for heart failure.
• This screening approach facilitates targeted interventions and prevention efforts in individuals predisposed to HF.
• The integration of functional capacity (6 MW) and ECG findings enhances the precision of HF risk stratification.