Dataset Information

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.

SUBMITTER: Kovell LC

PROVIDER: S-EPMC4501734 | biostudies-literature | 2015

REPOSITORIES: biostudies-literature

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Publications

Stage A Heart Failure Is Not Adequately Recognized in US Adults: Analysis of the National Health and Nutrition Examination Surveys, 2007-2010.

Kovell Lara C LC Juraschek Stephen P SP Russell Stuart D SD

PloS one 20150714 7

<h4>Background</h4>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.<h4>Methods</h4>We examined all adults with Stage A HF (≥20 years, N =4,470) in the National Health and Nutrit ...[more]

PMID: 26171960

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Project description:Hypertension doubles coronary heart disease (CHD) risk. Treating hypertension only reduces CHD risk ?25%. Treating hypercholesterolemia in hypertensive patients reduces residual CHD risk >35%.To assess progress in concurrent hypertension and hypercholesterolemia control, National Health and Nutrition Examination Surveys 1988 to 1994, 1999 to 2004, and 2005 to 2010 were analyzed. Hypertension was defined by blood pressure ?140/?90 mm?Hg, current medication treatment, and 2-told hypertension status; blood pressure <140/<90 defined control. Hypercholesterolemia was defined by ATP III criteria based on 10-year CHD risk, low-density lipoprotein cholesterol (LDL-C), and non-high-density lipoprotein cholesterol; values below diagnostic thresholds defined control. Across surveys, 60.7% to 64.3% of hypertensives were hypercholesterolemic. From 1988 to 1994 to 2005 to 2010, control of LDL-C rose (9.2% [95% confidence interval (CI), 6.6%-11.9%] to 45.4% [95% CI, 42.6%-48.3%]), concomitant hypertension and LDL-C (5.0% [95% CI, 3.3%-6.7%] to 30.7% [95% CI, 27.9%-33.4%]), and combined hypertension, LDL-C, and non-high-density lipoprotein cholesterol (1.8% [95% CI, 0.4%-3.2%] to 26.9% [95% CI, 24.4%-29.5%]). By multivariable logistic regression, factors associated with concomitant hypertension, LDL-C, and non-high-density lipoprotein cholesterol control (odds ratio [95% CI]) were statin (10.7 [8.1-14.3]) and antihypertensive (3.32 [2.45-4.50]) medications, age (0.77 [0.69-0.88]/10-year increase), ?2 healthcare visits/yr (1.90 [1.26-2.87]), black race (0.59 [0.44-0.80]), Hispanic ethnicity (0.62 [0.43-0.90]), cardiovascular disease (0.44 [0.34-0.56]), and diabetes mellitus (0.54 [0.42-0.70]).Despite progress, opportunities for improving concomitant hypertension and hypercholesterolemia control persist. Prescribing antihypertensive and antihyperlipidemic medications to achieve treatment goals, especially for older, minority, diabetic, and cardiovascular disease patients, and accessing healthcare at least biannually could improve concurrent risk factor control and CHD prevention.

Dataset Information

Stage A Heart Failure Is Not Adequately Recognized in US Adults: Analysis of the National Health and Nutrition Examination Surveys, 2007-2010.

Background

Methods

Results

Conclusions

Publications

Stage A Heart Failure Is Not Adequately Recognized in US Adults: Analysis of the National Health and Nutrition Examination Surveys, 2007-2010.

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