New HF criteria set sizeable shift of individuals from stage A to B

The new standards for heart failure (HF) staging proposed in the 2022 American College of Cardiology (ACC)/American Heart Association (AHA)/Heart Failure Society of America (HFSA) clinical practice guideline has led to a considerable change among community-based individuals from stage A to B.

“Those with stage B HF in the new system were at high risk for progression to symptomatic HF,” the investigators said.

Participants from three longitudinal cohort studies (Multi-Ethnic Study of Atherosclerosis, Cardiovascular Health Study, and Framingham Heart Study) were categorized into four HF stages according to the 2013 and 2022 criteria. The investigators then assessed the predictors of progression to symptomatic HF and adverse clinical outcomes associated with each HF stage using Cox proportional hazards regression.

A total of 11,618 participants were included. Based on the 2022 staging, 1,943 (16.7 percent) were deemed healthy, 4,348 (37.4 percent) were in stage A (at risk), 5,019 (43.2 percent) were in stage B (pre-HF), and 308 (2.7 percent) were in stage C/D (symptomatic HF).

When compared to the classification and definition described in the 2013 guidelines, the 2022 ACC/AHA/HFSA approach gave risk to a higher number of individuals with stage B HF, increasing from 15.9 percent to 43.2 percent. This shift disproportionately involved women as well as individuals with Black and Hispanic ethnicity.

Notably, the relative risk of progression to symptomatic HF did not significantly change (hazard ratio, 10.61, 95 percent confidence interval, 9.00‒12.51; p<0.001) despite the 2022 criteria assigning a greater proportion of individuals as stage B.