Abstract 11159: Prevalence and Prognostic Relevance of Heart Failure Stages Among Black Americans in the Community: The Jackson Heart Study

Abstract

Introduction: Black Americans experience a heightened risk of heart failure (HF) and develop HF at earlier ages than other racial/ethnic groups. Limited data exist regarding the prevalence and prognostic relevance of ACC/AHA HF stages among Black Americans. We aimed to quantify the distribution and prognostic relevance of ACC/AHA HF stages among Black Americans in mid- and late-life. Methods: We classified 4,763 Black participants in the community-based Jackson Heart Study who underwent echocardiography at study Exam 1 (2000-2004) by HF stage as follows: Stage A: presence of clinical HF risk factors (prevalent cardiovascular disease, hypertension, diabetes, obesity, metabolic syndrome, or chronic kidney disease) in the absence of structural heart disease; Stage B: structural heart disease (LVEF <50%, LV hypertrophy or enlargement, moderate to severe valvular disease); and Stage C: prevalent HF. Multivariable Cox proportional hazard regression models adjusted for age and gender were used to assess the associations of the HF stage at Exam 1 with incident HF hospitalization and all-cause mortality post-Exam 1. Results: Mean age was 55.3 ± 12.7 years and 64% were women. No clinical risk factors or cardiac structural or functional abnormalities (Stage 0) were present in 13% of participants. Stage A was present in 59%, Stage B was present in 26%, and prevalent HF (Stage C) was present in 3%. Over a median of 12.8 [IQR 11.8-13.5] years follow up, 332 participants developed HF and 1,060 participants died. Compared to those free of risk factors or structural remodeling (Stage 0), a more advanced HF stage was associated with greater risk of incident HF, and the composite of HF or death (Figure). Conclusions: In this large community-based cohort of Black Americans, HF risk factors (Stage A) and/or asymptomatic structural heart disease (Stage B) was present in 85% of participants. Stage A and Stage B were each associated with heightened risk of HF hospitalization.