Reclassification of Pre-Heart Failure Stages Using Cardiac Biomarkers The ARIC Study

BACKGROUND The recent heart failure (HF) guideline recommends the inclusion of cardiac biomarkers in defining Stage B HF. OBJECTIVES The authors evaluated the impact of incorporating cardiac biomarkers to reclassify HF in 5,324 partici- pants (mean age: 75.8 years) without prevalent HF enrolled in the ARIC (Atherosclerosis Risk In Communities) study and assessed prognosis of Stage B using cardiac biomarkers.METHODS Using N-terminal pro-B-type natriuretic peptide (<125 pg/mL or >= 125 pg/mL), high-sensitivity troponin T (<14 ng/L or >= 14 ng/L), and abnormal cardiac structure/function by echocardiography, individuals were classified as Stage Anew and Stage Bnew HF, respectively. Stage Bnew was further evaluated as elevated biomarker only, abnormal echocardiogram only, and abnormalities in both (echo thorn biomarker). The authors assessed risk for incident HF and all-cause death using Cox regression.RESULTS Overall, 4,326 (81.3%) individuals were classified as Stage Bnew with 1,123 (21.1%) meeting criteria for elevated biomarkers only. Compared with Stage Anew, Stage Bnew was associated with increased risk for incident HF (HR: 3.70 [95% CI: 2.58-5.30]) and death (HR: 1.94 [95% CI: 1.53-2.46]). Stage Bbiomarkers only and Stage Becho only were associated with increased HF risk, whereas Stage Bbiomarkers only was also associated with increased death. Stage Becho thorn biomarker had the highest risk for HF (HR: 6.34 [95% CI: 4.37-9.19]) and death (HR: 2.53 [95% CI: 1.98-3.23]).CONCLUSIONS Incorporating biomarkers based on the new HF guideline reclassified approximately 1 in 5 older adults without prevalent HF to Stage B. The routine measurement of biomarkers can help to identify individuals at higher HF risk who may benefit most from HF prevention efforts. (J Am Coll Cardiol HF 2023;11:440-450) Published by Elsevier on behalf of the American College of Cardiology Foundation.