Preventing new-onset heart failure: Intervening at stage A

Abstract

Heart failure (HF) prevention is an urgent public health need with national and global implications. Stage A HF patients do not show HF symptoms or structural heart disease but are at risk of HF development. There are no unique recommendations on detecting Stage A patients. Patients in Stage A are heterogeneous; many patients have different combinations of risk factors and, therefore, have markedly different absolute risks for HF. Comprehensive strategies to prevent HF at Stage A include intensive blood pressure lowering, adequate glycemic and lipid management, and heart-healthy behaviors (adopting Life's Essential 8). First and foremost, it is imperative to improve public awareness of HF risk factors and implement healthy lifestyle choices very early. In addition, recognize the HF risk-enhancing factors, which are nontraditional cardiovascular (CV) risk factors that identify individuals at high risk for HF (genetic susceptibility for HF, atrial fibrillation, chronic kidney disease, chronic liver disease, chronic inflammatory disease, sleep-disordered breathing, adverse pregnancy outcomes, radiation therapy, a history of cardiotoxic chemotherapy exposure, and COVID-19). Early use of biomarkers, imaging markers, and echocardiography (noninvasive measures of subclinical systolic and diastolic dysfunction) may enhance risk prediction among individuals without established CV disease and prevent chemotherapy-induced cardiomyopathy. Efforts are needed to address social determinants of HF risk for primordial HF prevention.Central illustrationPolicies developed by organizations such as the American Heart Association, American College of Cardiology, and the American Diabetes Association to reduce CV disease events must go beyond secondary prevention and encompass primordial and primary prevention.

Keywords: Cardiovascular Risk factors; Early Intervention; Heart failure; Primary prevention; Stage a heart failure.

Fig. 1

Clinical significance of Stage A heart failure (HF).

Fig. 2

Prevalence of stages of heart failure (HF).

Fig. 3

Mechanism of action of sodium-glucose cotransporter 2 inhibitors.

Fig. 4

The forest diagram of the occurrence of MACE.

Fig. 5

Obesity and heart failure risk—pathophysiology.

Fig. 6

Social determinants of heart failure.

Fig. 7

An example of predicted 10-year HF risk using the online Pooled Cohort Equations to Prevent Heart Failure (PCP-HF) tool. (Reproduced from J Am Coll Cardiol. 2019 May 21;73:2388–2397.