Timothy Anderson, assistant professor of medicine, University of Pittsburgh. Photography by John Dillard.
By Phoebe Ingraham Renda
Assessing patient risk for developing a health condition and providing recommendations to lower that risk is a cornerstone of primary care. However, when it comes to heart failure (HF), risk prediction is typically limited. But now, in a study published today in Annals of Internal Medicine, the American Heart Association’s Predicting Risk of Cardiovascular Disease EVENTs (PREVENT) equations made it possible to assess widespread HF risk—and reveal an estimated 15 million adults in the United States may be at risk.
Developed in November 2023, the PREVENT equations provide 10-year risk estimates of atherosclerotic cardiovascular disease (ASCVD), total cardiovascular disease and, uniquely, HF risk. Compared to previous calculators, the PREVENT equations use more robust, race-free, and diverse health information that includes biologically relevant measures, like kidney and metabolic health, to provide risk scores representative of the current U.S. population.
The HF calculator is the first to use only routinely collected clinical data, like age, body mass index and estimated glomerular filtration rate, to make accurate risk predictions. Previous HF calculators have had limited clinical uptake due to requirements for specialized data, like cardiac ultrasounds, says corresponding author, Timothy Anderson, assistant professor of medicine at the University of Pittsburgh and a primary care physician at UPMC.
Using the PREVENT equations, Anderson and colleagues assessed the prevalence of U.S. adults at risk for HF and ASCVD. Their study population consisted of 4,872 participants (ages 30-79 years) without known cardiovascular disease who participated in the combined 2017 to March 2020 cycle of the National Health and Nutrition Examination Survey, representing more than 143 million U.S. adults.
“We specifically wanted to answer the question of whether there's a unique group of people who are at high risk for heart failure but at a lower risk for events like heart attacks,” says Anderson. “That would be the group for which there might be a need for a new set of recommendations.”
For their analysis, the team calculated the 10-year risks of HF and ASCVD for each participant and compared both risk groups to assess associated risk factors. The calculator classified 15 million adults as having an elevated (greater than 10%) 10-year risk for HF. As expected, HF risk correlated with ASCVD risk, as some factors, like elevated blood pressure and weight, contribute to both conditions. However, other key determinants of vascular health, like high cholesterol, were not predictive of HF. Elevated HF risk was also correlated with age, in which 70 to 79-year-olds make up 62% of the elevated-risk group.
Beyond expected correlations, the risk calculator estimated that more than 4 million U.S. adults have an elevated HF risk but a low ASCVD risk. Of these adults, medically uncontrolled risk factors, like high blood pressure and obesity, were the most predictive of increased HF risk.
“The patterns of people at risk for heart failure largely track with the same patterns seen in patients with heart failure,” says Anderson. “Age is the biggest driver, but age is not modifiable—high blood pressure and obesity are the risk factors we can address early.”
While managing obesity and hypertension is crucial for overall health, recognizing their link to HF can help primary care providers identify patients who may benefit from additional treatment interventions.
“The next step needed is clinical practice guidelines that provide frameworks for primary care physicians and other clinicians on how to use these calculators to customize patient care,” says Anderson.
Anderson also notes that future prospective studies will help show that managing risk factors in people with increased HF risk leads to improved outcomes, as compared to recommendations already in place.