Unrealized opportunities for heart failure prevention in CVD: ABC-HF risk stratification and outpatient target attainment
V Medovchshikov, N Yeshniyazov, G Yussupova, M Balabayeva, Z H Iskakova, D Murzagaliyeva, S Azhgaliyeva, B Duisenbayev, G Kurmanalina, B Zholdin, E Khasanova, Z H KobalavaAbstract
Purpose
To evaluate clinical characteristics and outpatient pharmacotherapy in patients with cardiovascular disease (CVD) according to the level of 5-year risk of developing heart failure (HF).
Methods
This single-center observational study included 723 patients aged ≥40 years with established CVD and hypertension who were enrolled at hospital admission for cardiovascular causes. Patients with previously diagnosed HF were excluded (n=421), leaving 302 patients without diagnosed HF for analysis. The 5-year risk of incident HF was assessed using the ABC-HF score and categorized as low (≤2 points), intermediate (3-5 points), high (6-9 points), and very high (≥10 points). For comparative analyses, patients were additionally grouped as high/very high versus low/intermediate risk. We assessed clinical characteristics, attainment of guideline-recommended targets for blood pressure (BP), LDL cholesterol (LDL-C), and HbA1c, as well as pre-hospital cardiovascular pharmacotherapy. Continuous variables are reported as median (IQR) and compared using non-parametric tests; categorical variables are presented as n (%) and compared using χ² or Fisher’s exact test, as appropriate.
Results
Among patients without diagnosed HF (n=302), ABC-HF classified the 5-year risk as low in 9.9% (n=30), intermediate in 13.6% (n=41), high in 37.1% (n=112), and very high in 39.4% (n=119). When dichotomized, 231 patients had high/very high risk and 71 had low/intermediate risk. High/very high-risk patients were older (median 69 (58; 77) vs 60 (55.5; 68.5) years; p<0.001), more often smokers (22.1% vs 4.2%; p<0.001), and had a higher burden of atherosclerotic CVD (74.5% vs 21.1%; p<0.001) and CKD (47.6% vs 31.0%; p=0.013), as well as more frequent asymptomatic LV systolic dysfunction (15.6% vs 4.2%; p=0.014). HbA1c was slightly higher in the high/very high-risk group (5.5 (5.1; 6.4) vs 5.3 (5.0; 5.8); p=0.013). Additional baseline characteristics are detailed in Fig. 1. Despite a higher risk profile, attainment of guideline-recommended targets was poor, particularly in the high/very high-risk group: BP targets were achieved in less than half of patients, while statin use was low and LDL-C targets were rarely met in either risk stratum (Fig. 2). Among patients with known T2DM, uptake of SGLT2 inhibitors was minimal (Fig. 2).
Conclusions
Most patients with CVD and hypertension but without diagnosed HF had high/very high 5-year HF risk by ABC-HF. In this highest-risk stratum, outpatient prevention was not aligned with risk level: BP control was suboptimal, lipid targets were rarely achieved, and evidence-based cardiometabolic therapies (including SGLT2 inhibitors in eligible patients) were underused. Risk-guided intensification of therapy and systematic target attainment may represent a readily available strategy to reduce future HF burden in routine care.Fig.1.Baseline characteristicsFor image description, please refer to the figure legend and surrounding text.Fig.2.Outpatient medical therapyFor image description, please refer to the figure legend and surrounding text.