The Prevalence of Stages of Heart Failure in Primary Care: a Population-Based Study.

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 ejection fraction (HFREF) and to determine BNP levels to identify HF in the adult population.This is a cross-sectional study including 633 individuals, aged ≥45 years old, 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 (TDE) 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 in stage 0, 20 pg/mL in stage A, 24 pg/mL in stage B, 93 pg/mL in HFPEF and 266 pg/mL in HFREF. The cut-off BNP level with optimal sensitivity (92%) and specificity (91%) to identify HF was 42 pg/mL.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 TDE, may facilitate early detection of stage A and B HF and allow implementation of interventions aimed at preventing progression to symptomatic HF.