Factors influencing transition to symptomatic heart failure in Stage-B asymptomatic patients -A report from the CHART-2 study

Background: Increasing prevalence of heart failure (HF) is an urgent public health issue worldwide. Although the ACC/AHA Guidelines emphasize the importance to prevent the development of HF in asymptomatic Stage-B patients, little is known about the etiology and predictors for transition to symptomatic HF in Stage-B patients. Method: Among the 10,219 subjects registered in our cohort, named as the Chronic Heart Failure Analysis and Registry in the Tohoku District 2 (CHART-2) study, we enrolled 4,463 Stage-B patients in the present study. We analyzed the predictors for de novo HF in asymptomatic Stage-B patients by Akaike's information criterion (AIC). Results: Mean age was 67.3±12.4 years old, and male patients accounted for 71%. Regarding etiologies for asymptomatic cardiac structure abnormalities, the prevalence of ischemic heart disease, valvular heart disease, and cardiomyopathy was 51, 19, and 10%, respectively. During the median follow-up period of 3.0 years, 280 deaths (6.0%), 103 cardiovascular deaths (2.2%) and 165 de novo HF requiring hospitalization (3.5%) were noted. A stepwise Cox regression analysis with AIC revealed that development of de novo HF in Stage-B patients could be predicted by age (Hazard ratio (HR) 1.02, P=0.013), diastolic blood pressure (DBP) (HR 0.97, P=0.001), paroxysmal atrial fibrillation (PAF) (HR 2.50, P70 yrs.), low DBP (