Epidemiology of Asymptomatic Pre-heart Failure: a Systematic Review

Abstract

Purpose of review: To quantify the prevalence of asymptomatic pre-heart failure (pre-HF), progression to more severe stages, and associated mortality.

Recent findings: A systematic review was conducted between 01 January 2010 and 12 March 2020 (PROSPERO: CRD42020176141). Data of interest included prevalence, disease progression, and mortality rates. In total, 1030 sources were identified, of which, 12 reported on pre-HF (using the ACC/AHA definition for stage B HF) and were eligible. Prevalence estimates of pre-HF ranged from 11 to 42.7% (10 sources) with higher estimates found in the elderly, in patients with hypertension, and in men. Three studies reported on disease progression with follow-up ranging from 13 months to 7 years. The incidence of symptomatic HF (HF/advanced HF) ranged from 0.63 to 9.8%, and all-cause mortality from 1.6 to 5.4%. Further research is required to investigate whether early detection and intervention can slow or stop the progression from asymptomatic to symptomatic HF.

Keywords: Disease progression; Mortality; Prevalence; Stage B heart failure.

Fig. 1

Evaluation and management of HF defined by ACC/AHA guidelines: evolution and recommended therapy by HF stage. Adapted from Hunt [50]. ACEI, angiotensin-converting enzyme inhibitors; ARB, angiotensin receptor blockers; EF, ejection fraction; FHx CM, family history of cardiomyopathy; HF, heart failure; LV, left ventricular LVH, left ventricular hypertrophy; MI, myocardial infarction

Fig. 2

PRISMA flow chart of searches on the epidemiology of stage B HF, as defined by ACC/AHA guidelines