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Background: The aims of this study are to evaluate the rate of progression of preclinical (Stage A and B) heart failure, identify associated characteristics, and evaluate long-term outcomes. Methods: Retrospective review of the Olmsted County Heart Function Study. Individuals categorized as Stage A or B heart failure at initial visit that returned for a second visit 4 years later were included. Logistic regression analyses evaluated group differences with adjustment for age and sex. Results: At visit 1, 413 (32%) individuals were classified as Stage A and 413 (32%) as Stage B. By visit 2, 146 (35%) individuals from Stage A progressed with the vast majority (n=142) progressing to Stage B. In comparison, a total of 23 (6%) individuals progressed from Stage B. A greater rate of progression was seen for Stage A compared with Stage B (8.7 per 100 person-years [95% CI, 7.4–10.2] versus 1.4 per 100 person-years [95% CI, 0.9–2.1];P &lt;0.001). NT-proBNP correlated with progression for Stage B (P =0.01), but not for Stage A (P =0.39). A multivariate model found female sex (odds ratio, 1.65 [95% CI, 1.05–2.58];P =0.03), increased E/e’ (odds ratio, 1.13 [95% CI, 1.02–1.26],P =0.02), and beta blocker use (odds ratio, 2.19 [95% CI, 1.25–3.82],P =0.006) were associated with progression for Stage A. There was a signal that cardiovascular mortality was higher in individuals who progressed, although not statistically significant (P =0.06 for Stage A andP =0.05 for Stage B).Conclusions: There is significant progression of preclinical heart failure in a community population, with progression rates higher for Stage A. NT-proBNP correlated with progression for Stage B, but not for Stage A. No statistically significant differences in long-term outcomes were seen. Study results have clinical implications important to help guide future heart failure screening and prevention strategies.

Progression of Preclinical Heart Failure: A Description of Stage A and B Heart Failure in a Community Population