Table 1.

ACC/AHA Heart Failure Staging System

HF Stage	Criteria for Definition
Healthy/0	Healthy participants, no cardiovascular risk factors, no symptoms of dyspnea or physical sign of edema
A	Presence of at least 1 of the following HF risk factors: Hypertension (SBP/DBP ≥140/90 mm Hg) Diabetes mellitus (fasting glucose ≥126 mg/dL or use of diabetes mellitus medication) Obesity (BMI ≥30 kg/m2) Smoking (current smokers or smokers during the past year) Dyslipidemia (total/HDL >5 or triglycerides ≥150 mg/dL or use of lipid‐lowering treatment) Coronary artery disease (excluding myocardial infarction) but no cardiac structural/functional abnormality on imaging studies
B	Presence of any of the following: Prior clinical myocardial infarction (ARIC definition) Echocardiographic evidence of asymptomatic left ventricular systolic dysfunction: left ventricular ejection fraction of <0.50 (corresponding to visual assessment of left ventricular ejection fraction [qualitative variable] and also by M‐mode measurements of fractional shortening of <0.29) Left ventricular hypertrophy (LVH)=(LV Mass/ht^2.7) >51 g/m(2.7) 38 Regional wall motion abnormality Left ventricular enlargement
C/D	Presence of HF using ARIC criteria: Based on review of hospitalization records for any evidence of relevant HF symptoms (new onset or worsening of shortness of breath, edema, paroxysmal nocturnal dyspnea, orthopnea, or hypoxia) or any mention of HF as the reason for the hospitalization. If the hospitalization included such evidence, a second more detailed abstraction of the medical records was completed that included recording elements of HF diagnostic criteria (based on Framingham, modified Boston, National Health and Nutrition Examination Survey, and Gothenburg criteria), HF diagnostic scheme using ICD‐9‐CM codes, diagnostic tests (imaging tests), biomarkers, and medications (see references 31 , 40 ).

ACC/AHA indicates American College of Cardiology/American Heart Association; ARIC, Atherosclerosis Risk in Communities Study; BMI, body mass index; HDL, high‐density lipoprotein; HF, heart failure; ICD‐9‐CM, International Classification of Diseases, Ninth Revision, Clinical Modification; and SBP/DBP, systolic blood pressure/diastolic blood pressure.