title: The Prevalence of Stages of Heart Failure in Primary Care: A Population-Based Study.
abstract: BACKGROUND
  Planning strategies to prevent heart failure (HF) in developing countries require epidemiologic data in primary care. The purpose of this study was to estimate the prevalence of HF stages and their phenotypes, HF with preserved ejection fraction (HFPEF), and HF with reduced EF (HFREF) and to determine B-type natriuretic peptide (BNP) levels to identify HF in the adult population.
  
  
  RESULTS
  This is a cross-sectional study including 633 individuals, aged ≥45 years, who were randomly selected and registered in a primary care program of a medium-sized city in Brazil. All participants were underwent clinical evaluations, BNP measurements, electrocardiograms, and tissue Doppler echocardiography in a single day. The participants were classified as stage 0 (healthy, 11.7%), stage A (risk factors, 36.6%), stage B (structural abnormalities, 42.7%), or stage C (symptomatic HF, 9.3%). Among patients with HF, 59% presented with HFPEF and 41% presented with HFREF. The mean BNP levels were 20 pg/mL(-1) in stage 0, 20 pg/mL(-1) in stage A, 24 pg/mL(-1) in stage B, 93 pg/mL(-1) in HFPEF, and 266 pg/mL(-1) in HFREF. The cutoff BNP level with optimal sensitivity (92%) and specificity (91%) to identify HF was 42 pg/mL(-1).
  
  
  CONCLUSIONS
  The present study demonstrated a high prevalence of individuals at risk for HF and the predominance of HFPEF in a primary care setting. The clinical examination, along with BNP and tissue Doppler echocardiography, may facilitate early detection of stages A and B HF and allow implementation of interventions aimed at preventing progression to symptomatic HF.
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil. Electronic address: lagoeiro@globo.com.
authors.forename: Antonio Lagoeiro
authors.initials: AL
authors.lastname: Jorge
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Maria Luiza G
authors.initials: ML
authors.lastname: Rosa
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Wolney A
authors.initials: WA
authors.lastname: Martins
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Dayse Mary S
authors.initials: DM
authors.lastname: Correia
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Luiz Claudio M
authors.initials: LC
authors.lastname: Fernandes
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Jean A
authors.initials: JA
authors.lastname: Costa
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Samuel D
authors.initials: SD
authors.lastname: Moscavitch
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Bruno Afonso L
authors.initials: BA
authors.lastname: Jorge
authors.affiliation: Fluminense Federal University, Rua Marquês do Paraná, 303-Centro, Niterói, Rio de Janeiro 24033-900, Brazil.
authors.forename: Evandro T
authors.initials: ET
authors.lastname: Mesquita
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil / Q000453:epidemiology; D003430:Cross-Sectional Studies; D015150:Echocardiography, Doppler; D004562:Electrocardiography; D005260:Female; D006333:Heart Failure / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000453:epidemiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D015995:Prevalence; D011320:Primary Health Care / Q000706:statistics & numerical data*; D013318:Stroke Volume
chemical_list: D020097:Natriuretic Peptide, Brain
keywords: Echocardiography; Epidemiology; Heart failure; Natriuretic peptides; Prevalence