Predicted Risk, Preclinical Heart Failure Measures, and Incident Heart Failure

Abstract

Background

The association of PREVENT-HF (Predicting Risk of Cardiovascular Events–Heart Failure) risk estimates with preclinical heart failure (HF) and whether preclinical HF measures add to the predictive utility of PREVENT-HF remain undefined.

Objectives

The aims of this study were to evaluate the association between PREVENT-HF risk estimates and preclinical HF, to examine how preclinical HF measures correspond to absolute HF risk within PREVENT-HF categories, and to determine whether they provide predictive value beyond the PREVENT-HF score.

Methods

The authors performed a prospective analysis of 2,714 ARIC (Atherosclerosis Risk In Communities) Visit 5 participants <80 years of age, without baseline cardiovascular disease. Preclinical HF was defined by elevated cardiac biomarkers (N-terminal of pro-b-type natriuretic peptide ≥125 pg/mL or high-sensitivity cardiac troponin T ≥22 ng/L/≥14 ng/L in men/women) and/or abnormal echocardiographic findings. Within PREVENT-HF 10-year risk categories (<7.5%, ≥7.5% to <10%, ≥10% to <15%, ≥15% to <20%, and ≥20%), we assessed preclinical HF prevalence and compared 10-year HF incidence rates for those with and without preclinical HF. We assessed changes in predictive utility by adding preclinical HF measures to PREVENT-HF.

Results

The mean age was 74 years, with 63% women, and 22% Black adults. Higher PREVENT-HF risk was associated with higher preclinical HF prevalence, with the highest prevalence of combined elevated biomarkers plus abnormal echocardiograms (37%) in those with PREVENT-HF ≥20%. Over a median follow-up of 9.9 years, 262 HF events occurred. Within PREVENT-HF categories, preclinical HF measures were strongly associated with absolute HF risk: among those with PREVENT-HF ≥20%, HF incidence rates (per 1,000 person-years) were 9.5 with no preclinical HF and 51.5 with elevated biomarkers plus abnormal echocardiography. Adding cardiac biomarkers to PREVENT-HF improved risk discrimination (C statistic change 0.69 to 0.75; P < 0.001) and reclassification (categorical Net Reclassification Index: 0.17; 95% CI: 0.09-0.26), with modest further improvement from adding echocardiographic measures.

Conclusions

Preclinical HF measures indicate higher absolute HF risk within PREVENT-HF categories and enhance HF risk prediction.