The Transition from Stage A to Stage B of Heart Failure: Risk Factors, Promoting Factors, and Opportunities for Prevention—An Update from the Italian Society of Cardiology Working Group on Heart Failure

Heart failure (HF) affects more than 60 million people worldwide, with significant discrepancies in diagnosis and management. Moreover, HF is associated with elevated mortality and hospitalization rates, increasing in the last decades. The universal definition of HF included a staging system (Stages A-D) specifically focused on disease progression. Patients "at risk" for HF (but without current or prior symptoms or signs of HF and without structural cardiac changes or elevated biomarkers of heart disease) represent stage A. The "pre-heart failure" refers to stage B, in which the patients display at least one of the following conditions: the evidence of structural heart disease, impaired cardiac function, or elevated cardiac biomarkers -such as troponins or natriuretic peptides. The specific purpose of this classification is to improve the early detection, risk stratification, and prevention of disease progression, promoting specific actions focused on the early risk identification and the optimization of metabolic and cardiovascular factors that could potentially favour the HF onset and progression. In this review, an expert panel analysed both the risk and the promoting factors for HF progression to early identify patients with higher risk of progression. In addition, a score has been proposed, based on a comprehensive evaluation of the patients through the identification of the HF risk factors, the natriuretic peptide levels, and the echocardiographic measurement, to help clinicians in early HF diagnosis. Overall, the lifestyle modifications and the intensive treatment of HF risk factors using old (ACEis/ARBs) and new drugs (SGLT2is, GLP1 RAs and nsMRAs) could prevent HF progression from stage A to stage B improving HF prognosis.