Millions of American adults face a 10% or higher risk for heart failure

Key takeaways:

• Over half of adults with the highest risk for HF were also with obesity or hypertension.
• The findings may increase the importance of interventions aimed at these risk factors.

As many as 15 million adults in the United States have a 10% or greater risk for heart failure, results of a research letter published in Annals of Internal Medicine showed.

The majority of those at higher risk for heart failure (HF) had uncontrolled modifiable risk factors for the condition, including obesity and hypertension, according to the researchers.

Identifying populations at such a risk, along with implementing prevention strategies, “has the potential for dramatic public health impact,” the researchers wrote.

HF continues to contribute to mortality in the U.S. Healio previously reported that HF-related mortality in 2021 reached levels not seen since 1999, ending decades’ worth of decline for such deaths.

Risk calculators for determining 10-year risk for atherosclerotic cardiovascular disease (ASCVD) are frequently used in clinical care, but the American Heart Association’s PREVENT calculator “is one of the first risk calculators for estimating 10-year risk of [HF], ” according to Linnea M. Wilson, MPH, a clinical research assistant at Beth Israel Lahey Health and study co-author.

“We sought to understand whether there is a unique group of individuals at elevated risk of [HF] who were not identified as high risk of [ASCVD] now that clinicians can identify this group preventative care may be tailored to them,” she told Healio.

In the analysis, the researchers assessed these risks among adults aged 30 to 79 years, who were not pregnant and without known CVD, using 2017 to 2020 National Health and Nutrition Examination Survey data.

Researchers classified risk for HF as low (below 10%), intermediate (10% to 19.9%) or elevated (20% or greater).

The study population included 4,872 participants, who represented 143.2 million Americans. Of those, 62.8% identified as white.

Wilson and colleagues found an average estimated 10-year risk for HF of 3.7% (95% CI, 3.5%-4%), with 15 million adults classified as having an intermediate or high HF risk.

They reported greater HF risk among older adults, as those aged 30 to 39 years and 70 to 79 years made up 0.3% (95% CI, 0%-0.9%) and 62.4% (95% CI, 57%-67.9%) of the elevated-risk group, respectively.

Black adults made up 9.7% (95% CI, 7%-12.4%) of the low-risk group and 14.2% (95% CI, 10%-18.4%) of the elevated-risk group, with risks otherwise being “fairly consistent” across other diverse populations, the researchers wrote.

They also noted a strong correlation between HF risk and ASCVD risk, with 4.6% (95% CI, 4.1%-5.1%) of adults — or 6.6 million — in a higher HF than ASCVD risk category and 0.9% (95% CI, 0.6%-1.2%) in a lower HF than ASCVD risk category.

Among adults with an elevated HF risk:

• 54.3% (95% CI, 48%-60.7%) had a systolic BP over 130 mmHg; and
• 55.6% (95% CI, 52.1%-59.2%) had a BMI over 30 kg/m².

The researchers pointed out that the prevalence of uncontrolled risk factors, apart from elevated BP, declined as age increased.

“If primary care clinicians use the PREVENT-HF calculator they can provide additional counseling to patients with elevated risk of [HF] on ways to reduce their risks,” Wilson told Healio. “This may include stronger recommendations for risk factor control, such as [BP] reduction and weight loss, using the risk score to help communicate the importance of risk factor control.”

There were some study limitations identified by the researchers. For example, the data used were self-reported, whereas PREVENT risk scores could not be validated.

The researchers concluded that further research should assess primary prevention among adults at high HF risk in randomized trials, “including discovering when and how to screen for HF and identifying best treatment practices.”