Table 1.
Definition of ACC/AHA heart failure stages and classification criteria employed in this study.
| HF Stage | ACC/AHA Guideline Definition | Operational Definition in This Analysis |
|---|---|---|
| Stage 0 | Not meeting criteria for HF Stages A, B, C, or D |
None of the following clinical risk factors: prevalent cardiovascular disease (coronary artery disease, stroke, or peripheral arterial disease), hypertension, diabetes, obesity, metabolic syndrome, or chronic kidney disease None of the following cardiac structural or functional abnormalities: Abnormal LVEF, regional wall motion abnormality, LV enlargement based on LVEDV indexed to BSA, left ventricular hypertrophy based on LV mass indexed to height2.7, moderate or greater aortic stenosis, aortic regurgitation, mitral regurgitation, or mitral stenosis. |
| Stage A | At high risk for HF but without structural heart disease or symptoms of HF |
At least one of the following clinical risk factors: prevalent cardiovascular disease (coronary artery disease, stroke, or peripheral arterial disease), hypertension, diabetes, obesity, metabolic syndrome, or chronic kidney disease None of the following cardiac structural or functional abnormalities: Abnormal LVEF, regional wall motion abnormality, LV enlargement based on LVEDV indexed to BSA, left ventricular hypertrophy based on LV mass indexed to height2.7, moderate or greater aortic stenosis, aortic regurgitation, mitral regurgitation, or mitral stenosis. |
| Stage B | Structural heart disease but without signs or symptoms of HF | At least one of the following cardiac structural or functional abnormalities: Abnormal LVEF, regional wall motion abnormality, LV enlargement based on LVEDV indexed to BSA, left ventricular hypertrophy based on LV mass indexed to height2.7, moderate or greater aortic stenosis, aortic regurgitation, mitral regurgitation, or mitral stenosis. |
| Stage C1 | Structural heart disease with prior or current symptoms of HF | Prevalent HF not identified through a previous hospitalization, and instead based on self-report of HF or treatment for HF with at least one of the following: (1) subsequent confirmation of self-report by treating physician or the participant, or (2) an NT-proBNP at ARIC Visit 4 or 5 of at least 125 pg/ml |
| Stage C2 | Prevalent HF identified through a previous hospitalization based on (1) committee adjudicated HF hospitalization since 2005,13 or (2) hospitalization with an ICD code 428 prior to 20058 | |
| Stage D* | Refractory HF requiring specialized interventions | Left ventricular assist device or chronic inotropic therapy |
Metabolic syndrome was defined as the presence of at least 3 of the following 5 metrics assessed at Visit 5: waist circumference ≥102 cm in men and ≥88 cm in women, fasting triglycerides ≥150 mg/dL, systolic blood pressure ≥130 mmHg or diastolic blood pressure ≥85 mmHg or prevalent hypertension, and fasting glucose >100 mg/dL or prevalent diabetes.
Abnormal LVEF based on ARIC reference limits (<57.4% in women or <59.0% in men), regional wall motion abnormality; LV enlargement based on LVEDV indexed to BSA above ARIC reference limits (>51.9 ml/m2 in women or >60.2 ml/m2 in men); left ventricular hypertrophy based on ARIC reference limits for LV mass indexed to height2.7 (>41.5 g/m2.7 in women or >45.0 g/m2.7 in men); moderate or greater aortic stenosis defined as a peak transaortic velocity >3.0 m/sec; moderate or greater aortic regurgitation based on visual estimation by a staff echocardiographer; moderate or greater mitral regurgitation based on a mitral regurgitation jet area-to-left atrial area ratio of >0.20; moderate or greater mitral stenosis based on a mean antegrade transmitral gradient of at least 5 mmHg.
Stage D HF could not be distinguished from Stage C2 on the basis of symptoms, as HF symptom severity was not assessed at Visit 5, and was therefore defined on the basis of advanced HF therapies (LVAD or chronic inotropic therapy).