Risk-Based Primary Prevention of Heart Failure: A Scientific Statement From the American Heart Association

Area of Science:

• Cardiology
• Preventive Medicine
• Public Health

Background:

• Heart failure (HF) poses a significant and growing burden on morbidity, mortality, and healthcare costs.
• Primary prevention strategies for HF are underdeveloped, necessitating a shift towards risk-based approaches.
• The cardiovascular-kidney-metabolic syndrome is increasingly recognized as a key phenotype driving HF risk.

Purpose of the Study:

• To review current evidence for accurate risk prediction in primary HF prevention.
• To define strategies for equitable and effective primary HF prevention.
• To propose implementation strategies for a risk-based primary prevention paradigm for HF.

Main Methods:

• Review of current scientific literature and clinical guidelines on HF risk prediction and prevention.
• Analysis of the utility of multivariable risk equations, including the PREDICT (Predicting Risk of Cardiovascular Disease Events) equations.
• Consideration of novel therapeutic agents and diagnostic tools for risk stratification and early detection.

Main Results:

• Recent guidelines now recommend multivariable risk equations for estimating HF risk.
• The PREDICT equations offer prediction of incident HF and total cardiovascular disease.
• Novel therapies, such as SGLT2 inhibitors, show potential for preventing HF by targeting multiple risk axes.

Conclusions:

• Translating opportunities into a risk-based HF prevention framework requires implementing PREDICT-HF equations.
• Targeted use of cardiac biomarkers and echocardiography can aid risk reclassification and early detection.
• Defining therapy-specific risk thresholds incorporating net benefit and cost-effectiveness is essential for successful implementation.