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Prevention of Heart Failure

AHA experts summarize heart failure epidemiology, describe evidence-based preventive interventions, and outline initiatives to advance awareness and understanding.

Sponsoring Organization: American Heart Association

Background and Purpose: Unlike other cardiovascular conditions, heart failure is increasing in prevalence. Given its impact on overall mortality, morbidity, quality of life, and healthcare costs, this trend heightens the importance of heart failure prevention. A panel convened by the American Heart Association summarized the known risk factors for heart failure; identified interventions to address these risk factors; and determined priorities for future research, education, and advocacy efforts to improve heart failure prevention.

Key Points:
1. In the U.S., approximately 5 million people have heart failure, with an estimated 550,000 new cases annually. Heart failure is the most common cause of hospitalization in Medicare-eligible adults and is estimated to account for more than $33 billion in healthcare expenditures annually. The lifetime risk for developing heart failure (per the Framingham study) exceeds 20% at age 40.

2. Factors contributing to the increasing prevalence of heart failure in developed countries include the aging of the population and improved care of patients with cardiovascular disease. In developing nations, increases in cardiovascular risk factors and diseases contribute to rising heart failure prevalence.

3. Despite the high prevalence of risk factors for heart failure, routinely screening asymptomatic persons at risk, using either LV function assessments or B-type natriuretic peptide assessment, cannot be recommended.

4. Heart failure is a final common pathway of several risk factors and cardiovascular diseases. Major risk factors include aging, hypertension, MI, diabetes, valvular disease, and obesity. In some persons, toxins (e.g., anthracyclines) or genetic polymorphisms contribute to heart failure risk. Minor risk factors include chronic kidney disease, sleep disordered breathing, smoking, and dyslipidemia.

5. Interventions to prevent cardiovascular events also reduce heart failure risk. Thus, medications — including ACE inhibitors, beta-blockers, antiplatelet agents, and statins — should be employed aggressively to guideline-recommended targets in patients with established atherosclerotic disease, dyslipidemia, hypertension, or diabetes.

6. Strategies to prevent or delay the onset of type 2 diabetes mellitus are likely to effectively reduce the incidence of heart failure.

7. Although still unproven to reduce heart failure incidence, glucose control in patients with established diabetes, smoking cessation, and measures to achieve and maintain normal body weight are probably important. Treatment of sleep disordered breathing and prevention of chronic kidney disease may also be useful.

8. Hypertension is clearly associated with increased risk for heart failure, highlighting the importance of achieving guideline-recommended blood pressure goals. Treating isolated systolic hypertension, although challenging, reduces incidence of heart failure even among the oldest old. When treated according to guidelines, blacks achieve the same level of blood pressure control as do non-Hispanic whites.

9. Current understanding of heart failure is suboptimal among both professionals and the public. Increasing awareness facilitates appropriate diagnosis, referral, and treatment.

Comment: The growing burden of heart failure increases the urgency of deploying effective strategies to prevent its occurrence. Although we know many important risk factors, and guidelines provide clear recommendations for what we should be doing to address these factors, achieving the goals of evidence-based interventions has been frustratingly elusive. Additional research is necessary in several areas, but perhaps our most important priority is to develop population-level approaches to controlling risk factors.

— Frederick A. Masoudi, MD, MSPH

Published in Journal Watch Cardiology May 21, 2008

Citation(s):

Schocken DD et al. Prevention of heart failure. A scientific statement from the American Heart Association Councils on Epidemiology and Prevention, Clinical Cardiology, Cardiovascular Nursing, and High Blood Pressure Research; Quality of Care and Outcomes Research Interdisciplinary Working Group; and Functional Genomics and Translational Biology Interdisciplinary Working Group. Circulation 2008 May 13; 117:2544.

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