With the rising incidence of heart failure (HF) and increasing burden of morbidity, mortality, and healthcare expenditures, primary prevention of HF targeting individuals in at-risk HF (Stage A) and pre-HF (Stage B) Stages has become increasingly important with the goal to decrease progression to symptomatic (Stage C) HF. Identification of risk based on traditional risk factors (e.g., cardiovascular health which can be assessed with the American Heart Association's Life's Essential 8 framework), adverse social determinants of health, inherited risk of cardiomyopathies, and identification of risk-enhancing factors, such as patients with viral disease, exposure to cardiotoxic chemotherapy, and history of adverse pregnancy outcomes should be the first step in evaluation for HF risk. Next, use of guideline-endorsed risk prediction tools such as Pooled Cohort Equations to Prevent Heart Failure provide quantification of absolute risk of HF based in traditional risk factors. Risk reduction through counseling on traditional risk factors is a core focus of implementation of prevention and may include the use of novel therapeutics that target specific pathways to reduce risk of HF, such as mineralocorticoid receptor agonists (e.g., fineronone), angiotensin-receptor/neprolysin inhibitors, and sodium glucose co-transporter-2 inhibitors. These interventions may be limited in at-risk populations who experience adverse social determinants and/or individuals who reside in rural areas. Thus, strategies like telemedicine may improve access to preventive care. Gaps in the current knowledge base for risk-based prevention of HF are highlighted to outline future research that may target approaches for risk assessment and risk-based prevention with the use of artificial intelligence, genomics-enhanced strategies, and pragmatic trials to develop a guideline-directed medical therapy approach to reduce risk among individuals with Stage A and Stage B HF.

中文翻译：

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优先考虑心力衰竭的一级预防：测量、修改和监测风险

随着心力衰竭 (HF) 发病率的上升以及发病率、死亡率和医疗支出负担的增加，针对心力衰竭高危人群（A 阶段）和心力衰竭前期（B 阶段）阶段的个体进行心力衰竭一级预防变得越来越重要目标是减少进展为有症状（C 期）心力衰竭。基于传统风险因素（例如，可以使用美国心脏协会的 Life's Essential 8 框架评估的心血管健康）、健康的不利社会决定因素、心肌病的遗传风险以及风险增强因素（例如患者）的风险识别患有病毒性疾病、接触心脏毒性化疗以及不良妊娠结局史应该是评估心力衰竭风险的第一步。接下来，使用指南认可的风险预测工具（例如预防心力衰竭的队列方程）可以根据传统风险因素对心力衰竭的绝对风险进行量化。通过对传统危险因素进行咨询来降低风险是实施预防的核心重点，可能包括使用针对特定途径的新型治疗方法来降低心力衰竭风险，例如盐皮质激素受体激动剂（例如费奈罗酮）、血管紧张素受体/脑啡肽酶抑制剂和钠葡萄糖协同转运蛋白 2 抑制剂。这些干预措施可能仅限于经历不利社会决定因素的高危人群和/或居住在农村地区的个人。因此，远程医疗等策略可能会改善获得预防性护理的机会。强调了当前基于风险的心力衰竭预防知识库中的差距，以概述未来的研究，这些研究可能针对风险评估和基于风险的预防方法，通过使用人工智能、基因组学增强策略和实用试验来制定指南- 定向药物治疗方法可降低 A 期和 B 期心力衰竭患者的风险。