Predicted Risk, Preclinical Heart Failure Measures, and Incident Heart Failure: The ARIC Study.

Area of Science:

• Cardiology
• Preventive Medicine
• Biomarkers and Diagnostics

Background:

• The predictive utility of PREVENT-HF risk estimates for preclinical heart failure (HF) is not well-defined.
• The added value of preclinical HF measures to existing risk scores like PREVENT-HF requires further investigation.

Purpose of the Study:

• To assess the association between PREVENT-HF risk estimates and preclinical HF.
• To determine how preclinical HF indicators correlate with absolute HF risk across PREVENT-HF categories.
• To evaluate if preclinical HF measures improve HF risk prediction beyond the PREVENT-HF score.

Main Methods:

• Prospective analysis of 2,714 Atherosclerosis Risk In Communities (ARIC) participants without cardiovascular disease.
• Preclinical HF defined by elevated cardiac biomarkers (NT-proBNP, hs-cTnT) and/or abnormal echocardiography.
• Prevalence and incidence of HF were analyzed across PREVENT-HF 10-year risk strata, with and without preclinical HF markers.

Main Results:

• Higher PREVENT-HF risk was linked to increased preclinical HF prevalence.
• Within the highest PREVENT-HF risk category (≥20%), HF incidence was substantially higher in those with preclinical HF (51.5 vs. 9.5 per 1,000 person-years).
• Adding cardiac biomarkers to PREVENT-HF significantly improved risk discrimination (C-statistic 0.69 to 0.75) and reclassification.

Conclusions:

• Preclinical HF measures are associated with elevated absolute HF risk within PREVENT-HF risk categories.
• Incorporating preclinical HF indicators, especially cardiac biomarkers, enhances the predictive accuracy of the PREVENT-HF score for heart failure.