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. 2021 Aug 9;28(9):924-934.
doi: 10.1177/2047487320922636. Epub 2020 May 6.

Prevalence and determinants of the precursor stages of heart failure: results from the population-based STAAB cohort study

Caroline Morbach  1   2 , Götz Gelbrich  1   3   4 , Theresa Tiffe  1   3 , Felizitas A Eichner  1   3 , Martin Christa  1   2 , Renate Mattern  1   2 , Margret Breunig  1   2 , Vladimir Cejka  1   2 , Martin Wagner  1   3 , Peter U Heuschmann  1   3   4 , Stefan Störk  1   2 ; STAAB consortium
Collaborators, Affiliations
Free article

Prevalence and determinants of the precursor stages of heart failure: results from the population-based STAAB cohort study

Caroline Morbach et al. Eur J Prev Cardiol. .
Free article

Abstract

Aims: Prevention of heart failure relies on the early identification and control of risk factors. We aimed to identify the frequency and characteristics of individuals at risk of heart failure in the general population.

Methods and results: We report cross-sectional data from the prospective Characteristics and Course of Heart Failure Stages A-B and Determinants of Progression (STAAB) cohort study investigating a representative sample of residents of Würzburg, Germany. Sampling was stratified 1:1 for sex and 10:27:27:27:10 for age groups of 30-39/40-49/50-59/60-69/70-79 years. Heart failure precursor stages were defined according to American College of Cardiology/American Heart Association: stage A (risk factors for heart failure), stage B (asymptomatic cardiac dysfunction). The main results were internally validated in the second half of the participants. The derivation sample comprised 2473 participants (51% women) with a distribution of 10%/28%/25%/27%/10% in respective age groups. Stages A and B were prevalent in 42% and 17% of subjects, respectively. Of stage B subjects, 31% had no risk factor qualifying for stage A (group 'B-not-A'). Compared to individuals in stage B with A criteria, B-not-A were younger, more often women, and had left ventricular dilation as the predominant B qualifying criterion (all P < 0.001). These results were confirmed in the validation sample (n = 2492).

Conclusion: We identified a hitherto undescribed group of asymptomatic individuals with cardiac dysfunction predisposing to heart failure, who lacked established heart failure risk factors and therefore would have been missed by conventional primary prevention. Further studies need to replicate this finding in independent cohorts and characterise their genetic and -omic profile and the inception of clinically overt heart failure in subjects of group B-not-A.

Keywords: Early stage; heart failure; risk factor; stage A; stage B.

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