Progression to more advanced stages of heart failure is common among older adults, especially those in earlier stages, according to new data presented at the Heart Failure Society of America (HFSA) 2025 Annual Scientific Meeting.

Heart failure affects approximately 6.7 million Americans, and the burden is disproportionately high among older people.

“Several studies have quantified heart failure stage prevalence in the past. However, little is known about the rates and predictors of heart failure stage progression, particularly among older adults,” Nicholas Talbot, MD, a third-year resident at the University of Texas Southwestern Medical Center in Dallas, said during a presentation of the data.

To learn more, Talbot and his colleagues examined the medical records of participants in the ARIC longitudinal community-based cohort study of cardiovascular health to quantify progression in American College of Cardiology/American Heart Association/Heart Failure Society of America heart failure stages over 6 years in late life and to identify readily accessible clinical characteristics and cardiac biomarkers associated with progression.

They looked at how participants’ heart health changed from their fifth visit, which occurred between 2011 and 2013, to their seventh visit, which occurred between 2018 and 2019. Participants’ average age was 74 years at the fifth visit and 81 at the seventh visit. Of the 6112 participants who completed ECG and biomarker assessment during their fifth visit, 2894 returned for their seventh visit.

The prevalences of no heart failure (stage 0) and stages A, B, and C changed from 3%, 17%, 78%, and 3%, respectively, at their fifth visit to 1%, 6%, 86%, and 8%, respectively, at the seventh visit. No participant had stage D heart failure.

More than one fifth of participants progressed to a higher stage over 6 years, with a threefold increase in stage C prevalence. Progression was particularly common among those at the lower stages during the earlier visit — 88% of stage 0 participants and 82% of stage A participants progressed to more serious heart failure between visits.

Across all stages combined, progression was more likely in men, older people, those with more comorbidities such as obesity and diabetes, and higher levels of biomarkers like NT-proBNP. Talbot also noted that the two covariates with the highest odds ratios for heart failure progression were coronary artery disease and atrial fibrillation.

“I think we can conclude that for older adults in a community, progression to more advanced stages of heart failure is very common, particularly among those who are at earlier stages at baseline,” Talbot said. “These findings highlight the burden of heart failure among older adults, and they emphasize the importance of vigilance and risk factor modification earlier.”

Daniel Garry, MD, cardiologist at the University of Minnesota, Minneapolis, and co-moderator of Talbot’s presentation, said it’s challenging to look at the progression of heart failure stages in older adults. It was a good study, he noted, but he would have liked to see it expanded to other age groups to tease out how other factors, such as the physical decline associated with ageing, affect disease progression.

“I think it would have also been really helpful to take a look at other age groups to compare them because there are a lot of other aspects, and I think the deconditioning is a big part of this too, so it’s multifactorial,” he told Medscape Medical News.