Heart Failure Stages Among Older Adults in the Community: The Atherosclerosis Risk in Communities Study

Amil M Shah, Brian Claggett, Laura R Loehr, Patricia P Chang, Kunihiro Matsushita, Dalane Kitzman, Suma Konety, Anna Kucharska-Newton, Carla A Sueta, Thomas H Mosley, Jacqueline D Wright, Joseph Coresh, Gerardo Heiss, Aaron R Folsom, Scott D Solomon, Amil M Shah, Brian Claggett, Laura R Loehr, Patricia P Chang, Kunihiro Matsushita, Dalane Kitzman, Suma Konety, Anna Kucharska-Newton, Carla A Sueta, Thomas H Mosley, Jacqueline D Wright, Joseph Coresh, Gerardo Heiss, Aaron R Folsom, Scott D Solomon

Abstract

Background: Although heart failure (HF) disproportionately affects older adults, little data exist regarding the prevalence of American College of Cardiology/American Heart Association HF stages among older individuals in the community. Additionally, the role of contemporary measures of longitudinal strain and diastolic dysfunction in defining HF stages is unclear.

Methods: HF stages were classified in 6118 participants in the Atherosclerosis Risk in Communities study (67-91 years of age) at the fifth study visit as follows: A (asymptomatic with HF risk factors but no cardiac structural or functional abnormalities), B (asymptomatic with structural abnormalities, defined as left ventricular hypertrophy, dilation or dysfunction, or significant valvular disease), C1 (clinical HF without prior hospitalization), and C2 (clinical HF with earlier hospitalization).

Results: Using the traditional definitions of HF stages, only 5% of examined participants were free of HF risk factors or structural heart disease (Stage 0), 52% were categorized as Stage A, 30% Stage B, 7% Stage C1, and 6% Stage C2. Worse HF stage was associated with a greater risk of incident HF hospitalization or death at a median follow-up of 608 days. Left ventricular (LV) ejection fraction was preserved in 77% and 65% in Stages C1 and C2, respectively. Incorporation of longitudinal strain and diastolic dysfunction into the Stage B definition reclassified 14% of the sample from Stage A to B and improved the net reclassification index (P=0.028) and integrated discrimination index (P=0.016). Abnormal LV structure, systolic function (based on LV ejection fraction and longitudinal strain), and diastolic function (based on e', E/e', and left atrial volume index) were each independently and additively associated with risk of incident HF hospitalization or death in Stage A and B participants.

Conclusions: The majority of older adults in the community are at risk for HF (Stages A or B), appreciably more compared with previous reports in younger community-based samples. LV ejection fraction is robustly preserved in at least two-thirds of older adults with prevalent HF (Stage C), highlighting the burden of HF with preserved LV ejection fraction in the elderly. LV diastolic function and longitudinal strain provide incremental prognostic value beyond conventional measures of LV structure and LV ejection fraction in identifying persons at risk for HF hospitalization or death.

Keywords: echocardiography; elderly; epidemiology; heart failure.

© 2016 American Heart Association, Inc.

Figures

Figure 1
Figure 1
Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B) prevalence among age categories; and (C) age-adjusted prevalence among subgroups defined by sex and race. One participant was classified as Stage D on the basis of having an LVAD (prevalence

Figure 1

Prevalence of heart failure stages.…

Figure 1

Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B)…

Figure 1
Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B) prevalence among age categories; and (C) age-adjusted prevalence among subgroups defined by sex and race. One participant was classified as Stage D on the basis of having an LVAD (prevalence

Figure 1

Prevalence of heart failure stages.…

Figure 1

Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B)…

Figure 1
Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B) prevalence among age categories; and (C) age-adjusted prevalence among subgroups defined by sex and race. One participant was classified as Stage D on the basis of having an LVAD (prevalence

Figure 2

Kaplan-Meyer survival curves for death…

Figure 2

Kaplan-Meyer survival curves for death (panel A), and the composite of death or…

Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.

Figure 2

Kaplan-Meyer survival curves for death…

Figure 2

Kaplan-Meyer survival curves for death (panel A), and the composite of death or…

Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.

Figure 3

Prevalence of cardiac structural abnormalities…

Figure 3

Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and…

Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.

Figure 3

Prevalence of cardiac structural abnormalities…

Figure 3

Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and…

Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons
All figures (9)
Similar articles
Cited by
References
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–327. - PubMed
    1. Herz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–2104. - PubMed
    1. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am J Prev Med. 2006;30:371–7. - PubMed
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55. - PubMed
Show all 60 references
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Figure 1
Figure 1
Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B) prevalence among age categories; and (C) age-adjusted prevalence among subgroups defined by sex and race. One participant was classified as Stage D on the basis of having an LVAD (prevalence

Figure 1

Prevalence of heart failure stages.…

Figure 1

Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B)…

Figure 1
Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B) prevalence among age categories; and (C) age-adjusted prevalence among subgroups defined by sex and race. One participant was classified as Stage D on the basis of having an LVAD (prevalence

Figure 2

Kaplan-Meyer survival curves for death…

Figure 2

Kaplan-Meyer survival curves for death (panel A), and the composite of death or…

Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.

Figure 2

Kaplan-Meyer survival curves for death…

Figure 2

Kaplan-Meyer survival curves for death (panel A), and the composite of death or…

Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.

Figure 3

Prevalence of cardiac structural abnormalities…

Figure 3

Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and…

Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.

Figure 3

Prevalence of cardiac structural abnormalities…

Figure 3

Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and…

Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons
All figures (9)
Similar articles
Cited by
References
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–327. - PubMed
    1. Herz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–2104. - PubMed
    1. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am J Prev Med. 2006;30:371–7. - PubMed
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55. - PubMed
Show all 60 references
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[x]
Cite
Copy Download .nbib .nbib
Format: AMA APA MLA NLM

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The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

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Figure 1
Figure 1
Prevalence of heart failure stages. (A) Prevalence in the study population overall; (B) prevalence among age categories; and (C) age-adjusted prevalence among subgroups defined by sex and race. One participant was classified as Stage D on the basis of having an LVAD (prevalence

Figure 2

Kaplan-Meyer survival curves for death…

Figure 2

Kaplan-Meyer survival curves for death (panel A), and the composite of death or…

Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.

Figure 2

Kaplan-Meyer survival curves for death…

Figure 2

Kaplan-Meyer survival curves for death (panel A), and the composite of death or…

Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.

Figure 3

Prevalence of cardiac structural abnormalities…

Figure 3

Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and…

Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.

Figure 3

Prevalence of cardiac structural abnormalities…

Figure 3

Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and…

Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons
All figures (9)
Similar articles
Cited by
References
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–327. - PubMed
    1. Herz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–2104. - PubMed
    1. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am J Prev Med. 2006;30:371–7. - PubMed
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55. - PubMed
Show all 60 references
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib .nbib
Format: AMA APA MLA NLM

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MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Follow NCBI
Figure 2
Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.
Figure 2
Figure 2
Kaplan-Meyer survival curves for death (panel A), and the composite of death or HF hospitalization (panel B), by HF Stage. Median follow-up time for the composite endpoint was 608 days (25th to 75th percentile range 469–761 days). Total number of events was 194. For the composite endpoint, estimates for HF Stage C2 are not provided as all participants in this stage had, by definition, experienced a previous HF hospitalization. Event rate is expressed per 100 person-years. Hazard ratios are adjusted for age, sex, race, and Field Center.
Figure 3
Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.
Figure 3
Figure 3
Prevalence of cardiac structural abnormalities and abnormal LVEF among (A) Stage C1 and (B) C2 heart failure participants in the study population overall, and separately in subgroups defined by sex and race.
Figure 4
Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons

Figure 4

Prevalence and prognostic relevance of…

Figure 4

Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function…

Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons
All figures (9)
Similar articles
Cited by
References
    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322. - PubMed
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–327. - PubMed
    1. Herz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–2104. - PubMed
    1. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am J Prev Med. 2006;30:371–7. - PubMed
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55. - PubMed
Show all 60 references
Related information
Full text links [x]
[x]
Cite
Copy Download .nbib .nbib
Format: AMA APA MLA NLM
Figure 4
Figure 4
Prevalence and prognostic relevance of abnormalities of LV structure, systolic, and diastolic function among elderly persons in the community. Panel A. Venn diagram demonstrating the prevalence of abnormalities of cardiac structure and function among participants with Stage B heart failure defined using abnormal LV strain and diastolic measures in addition to abnormal LVEF, LVH, LV enlargement, and valvular disease. Values for NT-proBNP and hs-TnT are median and interquaritile range. For biomarker levels, P for all between group comparisons
All figures (9)

References

    1. Mozaffarian D, Benjamin EJ, Go AS, Arnett DK, Blaha MJ, Cushman M, de Ferranti S, Després JP, Fullerton HJ, Howard VJ, Huffman MD, Judd SE, Kissela BM, Lackland DT, Lichtman JH, Lisabeth LD, Liu S, Mackey RH, Matchar DB, McGuire DK, Mohler ER, 3rd, Moy CS, Muntner P, Mussolino ME, Nasir K, Neumar RW, Nichol G, Palaniappan L, Pandey DK, Reeves MJ, Rodriguez CJ, Sorlie PD, Stein J, Towfighi A, Turan TN, Virani SS, Willey JZ, Woo D, Yeh RW, Turner MB American Heart Association Statistics Committee and Stroke Statistics Subcommittee. Heart disease and stroke statistics--2015 update: a report from the American Heart Association. Circulation. 2015;131:e29–322.
    1. Yancy CW, Jessup M, Bozkurt B, Butler J, Casey DE, Jr, Drazner MH, Fonarow GC, Geraci SA, Horwich T, Januzzi JL, Johnson MR, Kasper EK, Levy WC, Masoudi FA, McBride PE, McMurray JJ, Mitchell JE, Peterson PN, Riegel B, Sam F, Stevenson LW, Tang WH, Tsai EJ, Wilkoff BL American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on practice guidelines. Circulation. 2013;128:e240–327.
    1. Herz RP, Unger AN, Cornell JA, Saunders E. Racial disparities in hypertension prevalence, awareness, and management. Arch Intern Med. 2005;165:2098–2104.
    1. Geiss LS, Pan L, Cadwell B, Gregg EW, Benjamin SM, Engelgau MM. Changes in incidence of diabetes in U.S. adults, 1997–2003. Am J Prev Med. 2006;30:371–7.
    1. Ogden CL, Carroll MD, Curtin LR, McDowell MA, Tabak CJ, Flegal KM. Prevalence of overweight and obesity in the United States, 1999–2004. JAMA. 2006;295:1549–55.
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