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(Circulation. 2007;115:1563-1570.)
© 2007 American Heart Association, Inc.

Heart Failure

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, MD; Steven J. Jacobsen, MD, PhD; Douglas W. Mahoney, MS; Jan A. Kors, PhD; Margaret M. Redfield, MD; John C. Burnett, Jr, MD; Richard J. Rodeheffer, MD

From the Division of Cardiovascular Diseases (K.A.A., M.M.R., J.C.B., R.J.R.) and Division of Epidemiology (S.J.J., D.W.M.), Mayo Clinic and Foundation, Rochester, Minn; and the Department of Medical Informatics (J.A.K.), Erasmus University Medical Center, Rotterdam, the Netherlands.

Correspondence to Khawaja Afzal Ammar, MD, Division of Cardiovascular Diseases, Mayo Clinic, 200 First St SW, Rochester, MN 55905. E-mail ammar.khawaja{at}mayo.edu

Received March 9, 2006; accepted December 18, 2006.

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.

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