Prevalence and prognostic significance of heart failure stages

Application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community

Khawaja Afzal Ammar, Steven J. Jacobsen, Douglas W. Mahoney, Jan A. Kors, Margaret May Redfield, John C Jr. Burnett, Richard J. Rodeheffer

Research output: Contribution to journalArticle

234 Citations (Scopus)

Abstract

BACKGROUND - Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association of HF stages with mortality. METHODS AND RESULTS - A population-based, cross-sectional, random sample of 2029 Olmsted County, Minnesota, residents aged ≥45 years was identified. Participants were classified by medical record review, symptom questionnaire, physical examination, and echocardiogram as follows: stage 0, healthy; stage A, HF risk factors; stage B, asymptomatic cardiac structural or functional abnormalities; stage C, HF symptoms; and stage D, severe HF. In the cohort, 32% were stage 0, 22% stage A, 34% stage B, 12% stage C, and 0.2% stage D. Mean B-type natriuretic peptide concentrations (in pg/mL) increased by stages: stage 0=26, stage A=32, stage B=53, stage C=137, and stage D=353. Survival at 5 years was 99% in stage 0, 97% in stage A, 96% in stage B, 75% in stage C, and 20% in stage D. CONCLUSIONS - The present study provides prevalence estimates and prognostic validation for HF staging in a community cohort. Of note, 56% of adults ≥45 years of age were classified as being in stage A (risk factors) or B (asymptomatic ventricular dysfunction). HF staging underscores the magnitude of the population at risk for progression to overt HF.

Original languageEnglish (US)
Pages (from-to)1563-1570
Number of pages8
JournalCirculation
Volume115
Issue number12
DOIs
StatePublished - Mar 2007

Fingerprint

Heart Failure
Mortality
Ventricular Dysfunction
Brain Natriuretic Peptide
Physical Examination
Medical Records
Cross-Sectional Studies
Morbidity
Population

Keywords

  • Epidemiology
  • Heart failure
  • Prevention
  • Ventricular dysfunction

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Prevalence and prognostic significance of heart failure stages : Application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community. / Ammar, Khawaja Afzal; Jacobsen, Steven J.; Mahoney, Douglas W.; Kors, Jan A.; Redfield, Margaret May; Burnett, John C Jr.; Rodeheffer, Richard J.

In: Circulation, Vol. 115, No. 12, 03.2007, p. 1563-1570.

Research output: Contribution to journalArticle

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title = "Prevalence and prognostic significance of heart failure stages: Application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community",
abstract = "BACKGROUND - Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association of HF stages with mortality. METHODS AND RESULTS - A population-based, cross-sectional, random sample of 2029 Olmsted County, Minnesota, residents aged ≥45 years was identified. Participants were classified by medical record review, symptom questionnaire, physical examination, and echocardiogram as follows: stage 0, healthy; stage A, HF risk factors; stage B, asymptomatic cardiac structural or functional abnormalities; stage C, HF symptoms; and stage D, severe HF. In the cohort, 32{\%} were stage 0, 22{\%} stage A, 34{\%} stage B, 12{\%} stage C, and 0.2{\%} stage D. Mean B-type natriuretic peptide concentrations (in pg/mL) increased by stages: stage 0=26, stage A=32, stage B=53, stage C=137, and stage D=353. Survival at 5 years was 99{\%} in stage 0, 97{\%} in stage A, 96{\%} in stage B, 75{\%} in stage C, and 20{\%} in stage D. CONCLUSIONS - The present study provides prevalence estimates and prognostic validation for HF staging in a community cohort. Of note, 56{\%} of adults ≥45 years of age were classified as being in stage A (risk factors) or B (asymptomatic ventricular dysfunction). HF staging underscores the magnitude of the population at risk for progression to overt HF.",
keywords = "Epidemiology, Heart failure, Prevention, Ventricular dysfunction",
author = "Ammar, {Khawaja Afzal} and Jacobsen, {Steven J.} and Mahoney, {Douglas W.} and Kors, {Jan A.} and Redfield, {Margaret May} and Burnett, {John C Jr.} and Rodeheffer, {Richard J.}",
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T1 - Prevalence and prognostic significance of heart failure stages

T2 - Application of the American College of Cardiology/American Heart Association heart failure staging criteria in the community

AU - Ammar, Khawaja Afzal

AU - Jacobsen, Steven J.

AU - Mahoney, Douglas W.

AU - Kors, Jan A.

AU - Redfield, Margaret May

AU - Burnett, John C Jr.

AU - Rodeheffer, Richard J.

PY - 2007/3

Y1 - 2007/3

N2 - BACKGROUND - Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association of HF stages with mortality. METHODS AND RESULTS - A population-based, cross-sectional, random sample of 2029 Olmsted County, Minnesota, residents aged ≥45 years was identified. Participants were classified by medical record review, symptom questionnaire, physical examination, and echocardiogram as follows: stage 0, healthy; stage A, HF risk factors; stage B, asymptomatic cardiac structural or functional abnormalities; stage C, HF symptoms; and stage D, severe HF. In the cohort, 32% were stage 0, 22% stage A, 34% stage B, 12% stage C, and 0.2% stage D. Mean B-type natriuretic peptide concentrations (in pg/mL) increased by stages: stage 0=26, stage A=32, stage B=53, stage C=137, and stage D=353. Survival at 5 years was 99% in stage 0, 97% in stage A, 96% in stage B, 75% in stage C, and 20% in stage D. CONCLUSIONS - The present study provides prevalence estimates and prognostic validation for HF staging in a community cohort. Of note, 56% of adults ≥45 years of age were classified as being in stage A (risk factors) or B (asymptomatic ventricular dysfunction). HF staging underscores the magnitude of the population at risk for progression to overt HF.

AB - BACKGROUND - Heart failure (HF) is a progressive disorder associated with frequent morbidity and mortality. An American Heart Association/American College of Cardiology staging classification of HF has been developed to emphasize early detection and prevention. The prevalence of HF stages and their association with mortality are unknown. We sought to estimate HF stage prevalence in the community and to measure the association of HF stages with mortality. METHODS AND RESULTS - A population-based, cross-sectional, random sample of 2029 Olmsted County, Minnesota, residents aged ≥45 years was identified. Participants were classified by medical record review, symptom questionnaire, physical examination, and echocardiogram as follows: stage 0, healthy; stage A, HF risk factors; stage B, asymptomatic cardiac structural or functional abnormalities; stage C, HF symptoms; and stage D, severe HF. In the cohort, 32% were stage 0, 22% stage A, 34% stage B, 12% stage C, and 0.2% stage D. Mean B-type natriuretic peptide concentrations (in pg/mL) increased by stages: stage 0=26, stage A=32, stage B=53, stage C=137, and stage D=353. Survival at 5 years was 99% in stage 0, 97% in stage A, 96% in stage B, 75% in stage C, and 20% in stage D. CONCLUSIONS - The present study provides prevalence estimates and prognostic validation for HF staging in a community cohort. Of note, 56% of adults ≥45 years of age were classified as being in stage A (risk factors) or B (asymptomatic ventricular dysfunction). HF staging underscores the magnitude of the population at risk for progression to overt HF.

KW - Epidemiology

KW - Heart failure

KW - Prevention

KW - Ventricular dysfunction

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JO - Circulation

JF - Circulation

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