Urgent Need for Primary Prevention in the Escalating Heart Failure Crisis

A significant rise in heart failure cases necessitates a focus on primary prevention strategies, as emphasized by a recent scientific statement from the American Heart Association (AHA) published in the journal Circulation. This statement consolidates current research on predicting heart failure risk and outlines prevention tactics.

Currently, approximately 6.7 million adults in the United States are diagnosed with heart failure, with projections indicating that this number could surpass 11 million by 2050. Heart failure has become the primary cause of hospital admissions among individuals aged 65 and over, with a concerning increase in incidence among younger populations. Additionally, mortality rates associated with heart failure have escalated, showcasing a 15% rise from 2018 to 2021.

The AHA report indicates that early identification of pre-heart failure and elevated risk factors can lead to effective prevention or delay of the condition through appropriate therapies. The AHA recommends utilizing the PREVENT (Predicting Risk of cardiovascular disease EVENT) risk calculator to assess individual risk levels.

The statement also sheds light on non-traditional risk factors that contribute to heart failure, which may often be overlooked. These include chronic inflammatory diseases, exposure to cardiotoxic substances, adverse pregnancy outcomes, metabolic dysfunction-associated steatotic liver disease (MASLD), and genetic predispositions.

Moreover, the importance of recognizing comorbid conditions is highlighted, particularly chronic kidney disease (CKD), which has a strong correlation with heart failure. Experts advocate for acknowledging CKD as a critical focus area for heart failure prevention, especially with the introduction of therapies designed to protect kidney health.

It is noteworthy that younger individuals are frequently perceived as low-risk for heart failure; however, conditions such as CKD, severe obesity, and diabetes can predispose them to heart failure, both in the short and long term. The PREVENT equations offer a comprehensive 30-year risk assessment, reinforcing the necessity for early interventions and preventive measures.

The AHA statement underscores the significance of lifestyle modifications and social determinants of health in managing heart failure risk. Experts stress that simply prescribing medications and recommending lifestyle changes may not suffice for all patients. Tailoring interventions to individual preferences, setting achievable targets, and providing consistent support through counseling and community resources can facilitate meaningful change.

Adopting a multidisciplinary approach to address heart failure is also deemed essential. This approach should encompass a range of professionals, including physicians, pharmacists, advanced practice clinicians, social workers, care navigators, and community health workers to effectively manage the complex nature of heart failure.

By identifying individuals at heightened risk earlier, intensive lifestyle interventions and more rigorous control of risk factors can significantly mitigate the likelihood of developing heart failure. With modern tools available for risk assessment and effective therapies at hand, healthcare providers are better equipped to tackle the growing heart failure epidemic.

For further reading, refer to Risk-Based Primary Prevention of Heart Failure: A Scientific Statement From the American Heart Association, published in Circulation.