Abstract Body (Do not enter title and authors here): Background: PREVENT-HF is a risk prediction tool recently developed by the AHA to estimate heart failure (HF) risk. The association of PREVENT-HF with measures of subclinical HF (stage B HF), and the clinical implications of subclinical HF measures within PREVENT-HF categories are undefined.

Methods: We performed a prospective analysis of 2,716 ARIC participants <80 years of age without prevalent HF or atherosclerotic cardiovascular disease who attended Visit 5 (2011-2013). We grouped participants into PREVENT-HF 10-year risk categories (<7.5%; ≥ 7.5 to < 10%; ≥ 10 to < 15%; ≥ 15 to < 20%; and ≥ 20%). We identified stage B HF based on elevated cardiac biomarkers (N-terminal pro B-type natriuretic peptide ≥125 pg/mL or high sensitivity troponin T ≥22 ng/L for men and ≥14 ng/L for women) and/or abnormal cardiac function or structure on echocardiography (echo). We assessed the prevalence of subclinical HF within each PREVENT-HF category. We calculated HF incidence rates (IRs) within each PREVENT-HF category and assessed HF IRs for those with elevated cardiac biomarkers alone, abnormal echo alone, both abnormal or neither.

Results: The mean age was 74 years, with 63% women and 22% Black adults and with 16%, 18%, 33%, 19% and 13% in PREVENT-HF 10-year risk categories of <7.5%; ≥ 7.5 to < 10%; ≥ 10 to < 15%; ≥ 15 to < 20%; and ≥ 20%, respectively. Higher PREVENT-HF estimated risk was associated with subclinical HF with the highest frequency of combination of both abnormal biomarkers + abnormal echo in 37% with PREVENT-HF ≥ 20%. Higher PREVENT-HF score was associated with a stepwise increase in HF IRs (Figure). Individuals with PREVENT-HF <10% had relatively low IRs for HF even in the presence of abnormal biomarkers + echo. In participants with higher PREVENT-HF scores, the presence of abnormal biomarkers + echo identified a subgroup at very high HF risk (IRs of 37 and 51 per 1000 person-years in those with PREVENT-HF ≥15 to < 20% and ≥20%, respectively), while the absence of abnormal biomarkers or echo identified a lower risk group.

Conclusion: Stage B HF improves HF risk stratification in those with higher PREVENT-HF estimates but provides limited utility for absolute HF risk stratification in those with PREVENT-HF <10%.