Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study
Authors' conclusion
The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared with previous reports in younger community-based samples. LV ejection fraction is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HF with preserved LV ejection fraction in the elderly. LV diastolic function and longitudinal strain provide incremental prognostic value beyond conventional measures of LV structure and LV ejection fraction in identifying persons at risk for HF hospitalization or death.
Study context
- Population
- Older adults (67–91 years) in the Atherosclerosis Risk in Communities study, fifth study visit
- Participants
- 6,118 adults
- Exposure
- Stage 0 vs A vs B vs C1 vs C2
- Outcome
- Prevalence of ACC/AHA HF stages
Methodological detailscommunity-based
- Community-based
Main finding
As reported in the abstract
Observational data: associations, not effects.
Further findings
Preserved LVEF in Stage C
Incident heart failure (HF) hospitalization or death by HF stage · median follow-up 608 days
- Worse HF stage associated with greater risk of incident HF hospitalization or death
Adding longitudinal strain and diastolic dysfunction to Stage B definition
- Reclassified from Stage A to B
- 14%
- Improved net reclassification index
- P = 0.028
- Improved integrated discrimination index
- P = 0.016
Incident HF hospitalization or death in Stage A and B
- Abnormal left ventricular (LV) structure, systolic function (LVEF, longitudinal strain) and diastolic function (e', E/e', left atrial volume index) each independently and additively associated with risk
Original publication
Summarised from the published abstract; every number is checked against it