Top Things to Know: Risk-Based Primary Prevention of Heart Failure
Prepared by EJ Cheon, PhD, Associate Science and Medicine Advisor; Bernadette Okwu-Gage PhD MPH MBBS Associate Science and Medicine Advisor
- The increasing morbidity, mortality, and health care costs associated with heart failure (HF) creates the urgent need to address primary prevention.
- This scientific statement integrates current HF prevention guidelines with practical strategies, illustrating how emerging evidence can enhance care for at-risk and pre-HF populations.
- The risk-based framework adapted from the ASCVD prevention guidelines for HF risk assessment emphasizes the CPR approach: Calculate risk using the PREVENT equation, Personalize based on risk factors, and Reclassify the risk through biomarkers and imaging.
- The PREVENT equation estimates HF risk over a 10- and 30-year period using clinical and social variables. It supports early identification of high-risk individuals.
- The framework also incorporates risk-enhancing factors such as chronic inflammatory diseases, cardiotoxic exposures, adverse pregnancy outcomes, metabolic dysfunction-associated steatotic liver disease, and inherited risk factors for individualized care.
- Biomarkers (e.g., natriuretic peptides, high sensitivity troponin etc.) and imaging (e.g., echocardiography) can identify subclinical HF, enabling earlier and more targeted interventions.
- The statement outlines practical steps for implementing the “Calculate-Personalize-Reclassify (CPR)” approach in clinical settings, ensuring that HF prevention strategies are both feasible and impactful.
- Detailed interventions include lifestyle modifications such as diet and physical activity and management of comorbidities like hypertension, diabetes, obesity, chronic kidney disease, and coronary artery disease using pharmacologic and non-pharmacologic therapies.
- The multi-level barriers to HF prevention includes socioeconomic disparities, healthcare access challenges, and the coverage and affordability of optimal monitoring and treatment. This statement advocates for addressing social determinants of health to achieve equitable HF prevention.
- To advance the practical implementation of HF prevention frameworks, further research on refining risk thresholds for therapy, integrating artificial intelligence for prediction, and evaluating cost-effectiveness of prevention strategies are required.
Citation
Khan SS, Breathett K, Braun LT, Chow SL, Gupta DK, Lekavich C, Lloyd- Jones DM, Ndumele CE, Rodriguez CJ, Allen LA; on behalf of the American Heart Association Prevention Science Committee of the Council on Epidemiology and Prevention; Council on Cardiovascular and Stroke Nursing; Council on Basic Cardiovascular Sciences; Council on Clinical Cardiology; Council on Hypertension; and Council on Quality of Care and Outcomes Research. Risk-based primary prevention of heart failure: a scientific statement from the American Heart Association. Circulation. Published online April 16, 2025. doi: 10.1161/CIR.0000000000001307