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Need and prospects for prevention of cardiac failure
1Department of Medicine, Boston University School of Medicine/Framingham Heart Study, MA 01701, USA.
Insights
Early detection of presymptomatic left ventricular dysfunction is crucial for reducing cardiac failure. Identifying high-risk individuals allows for targeted preventive treatments to delay heart failure onset and improve survival.
Area of Science:
- Cardiology
- Preventive Medicine
- Epidemiology
Background:
- Cardiac failure is a life-threatening condition with poor prognosis, often occurring as the final stage of cardiovascular disease.
- Despite declining cardiac disease mortality, the incidence and prevalence of cardiac failure remain high.
- Effective reduction in cardiac failure requires early identification and management of presymptomatic left ventricular dysfunction and its risk factors.
Purpose of the Study:
- To develop and validate methods for identifying individuals at high risk of developing cardiac failure.
- To enable cost-effective, targeted preventive interventions for high-risk populations.
- To reduce the incidence and mortality associated with cardiac failure.
Main Methods:
- Epidemiologic research to identify independent predictors of heart failure.
- Construction of multivariable risk profiles using logistic functions.
- Inclusion of variables such as age, blood pressure, vital capacity, heart rate, ECG-LVH, cardiac enlargement, glucose intolerance, and coronary heart disease or valvular deformity.
Main Results:
- Multivariate risk profiles effectively predict congestive heart failure (CHF).
- Approximately 80% of CHF events occur in the highest risk quintile.
- High-risk individuals frequently exhibit echocardiographic evidence of impaired cardiac function.
Conclusions:
- Identification of high-risk individuals for CHF is feasible through multivariate risk profiling.
- Targeted preventive strategies, including ACE inhibitors, can benefit high-risk patients with impaired cardiac function.
- Early intervention in presymptomatic individuals is key to delaying cardiac failure and improving outcomes.
Abstract:
Cardiac failure is a lethal end-stage of cardiovascular disease. Survival, once the heart has used up all its reserve and compensatory mechanisms, is little better than for cancer. Once overt failure ensues median survival is only 1.7 years for men and 3.2 years for women, and sudden death is a common mode of exitus. Recent declines in death rates from cardiac disease have not been accompanied by a reduced prevalence or incidence of cardiac failure. A substantial reduction in cardiac failure incidence and mortality requires the detection and correction of presymptomatic left ventricular dysfunction and the risk factors which predispose to its occurrence. Major contributors to the development of cardiac failure have been delineated and quantified. Methods for efficiently identifying presymptomatic candidates for cardiac failure for preventive measures have been developed. High-risk candidates can now be cost-effectively targeted for treatment to delay failure. Independent predictors of heart failure have been identified by epidemiologic research which enable construction of multivariable risk profiles that efficiently predict congestive heart failure (CHF). The conditional probability of an event can be estimated over a wide range using a logistic function including the variables of age, systolic blood pressure, vital capacity, heart rate, ECG-LVH, X-ray cardiac enlargement, glucose intolerance, and coronary heart disease or valvular deformity. In this way it is possible to identify high-risk candidates for CHF. Some 80% of CHF events occur in persons in the upper quintile of multivariate risk. These persons at high risk yield a high prevalence of persons with echocardiographic evidence of impaired cardiac function likely to benefit from vigorous preventive management including angiotensin-converting enzyme (ACE) inhibitors.