title: Stage A Heart Failure Is Not Adequately Recognized in US Adults: Analysis of the National Health and Nutrition Examination Surveys, 2007-2010.
abstract: BACKGROUND
  Stage A heart failure (HF) is defined as people without HF symptoms or structural heart disease, but with predisposing conditions for HF. This classification is used to identify high risk patients to prevent progression to symptomatic HF. While guidelines exist for managing HF risk factors, achievement of treatment goals in the United States (US) population is unknown.
  
  
  METHODS
  We examined all adults with Stage A HF (≥20 years, N =4,470) in the National Health and Nutrition Examination Surveys (NHANES) 2007-2010, a nationally representative sample. Stage A HF was defined by coronary heart disease (CHD), hypertension, diabetes mellitus, or chronic kidney disease. We evaluated whether nationally accepted guidelines for risk factor control were achieved in Stage A patients, including sodium intake, body mass index, hemoglobin A1c (HbA1c), cholesterol, and blood pressure (BP). Pharmacologic interventions and socioeconomic factors associated with guideline compliance were also assessed.
  
  
  RESULTS
  Over 75 million people, or 1 in 3 US adults, have Stage A HF. The mean age of the Stage A population was 56.9 years and 51.5% were women. Seventy-two percent consume ≥2g sodium/day and 49.2% are obese. Of those with CHD, 58.6% were on a statin and 51.8% were on a beta-blocker. In people with diabetes, 43.6% had HbA1c ≥7%, with Mexican Americans more likely to have HbA1c ≥7% . Of those with hypertension, 30.8% had a systolic BP ≥140 or diastolic BP ≥90 mm Hg. Having health insurance was associated with controlled blood pressure, both in those with hypertension and diabetes. In CHD patients, income ≥$20,000/year and health insurance were inversely associated with LDL ≥100mg/dL with prevalence ratio (PR) of 0.58 (P=0.03) and 0.56 (P=0.03), respectively.
  
  
  CONCLUSIONS
  One-third of the US adult population has Stage A HF. Prevention efforts should focus on those with poorly controlled comorbid disease.
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Lara C
authors.initials: LC
authors.lastname: Kovell
authors.affiliation: Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, United States of America.
authors.forename: Stephen P
authors.initials: SP
authors.lastname: Juraschek
authors.affiliation: Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States of America.
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
mesh_terms: D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D018450:Disease Progression; D005260:Female; D006306:Health Surveys; D006333:Heart Failure / Q000453:epidemiology* / Q000517:prevention & control* / Q000628:therapy; D006801:Humans; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult