Prevention of “Failure”
Is It a Failure of Prevention?
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The onset of symptomatic heart failure (HF) remains associated with a poor prognosis despite many advances in therapies and enormous resources spent on both treatment and research for advanced symptomatic HF. Therefore, prevention of HF is critical. Reviewing and mirroring successful strategies that have helped in the prevention of atherosclerotic cardiovascular disease (ASCVD), in which significant advances have been made in recent decades, may help guide our efforts in preventing HF.
Quantitative assessment of an individual’s ASCVD risk with tools such as the Framingham Risk Score has been used in guidelines throughout the world as the initial step to guide the intensity of risk factor modification with lifestyle and drug therapy. After initial efforts in classifying individuals at risk for HF as stage A/B resulted in the majority of individuals being classified as at risk, HF-specific clinical risk scores were recently developed; however, most primary care providers and even cardiologists are unaware of their existence. The 2013 American College of Cardiology/American Heart Association HF guidelines do not endorse any specific risk assessment tool, but the 2017 update and the recent American Heart Association scientific statement review the potential value of biomarkers in HF risk assessment.
These advances in HF risk estimation using algorithms that include biomarkers allow quantitative identification of higher-risk individuals. Multiple studies, including the Atherosclerosis Risk in Communities study, have shown the value of candidate biomarkers such as troponin T (measured with a highly sensitive assay) and NT-proBNP (N-terminal pro–B-type natriuretic peptide) in predicting HF …