Administrative Data–Based Staging of the Heart Failure Continuum in a Nationwide Population

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Abstract Background Population-level data on preclinical heart failure (HF) remain limited because most epidemiological studies focus on symptomatic HF. We therefore developed an administrative-data algorithm to classify HF stages across the national population and describe temporal trends, stage transitions, and mortality across the HF continuum. Methods Using a claims-based staging framework adapted from the Universal Definition of HF, we classified HF stages from ICD-10 codes, prescription records, and medical procedures. We applied this algorithm to the Czech population, linking the National Registry of Reimbursed Health Services to National mortality records from 2015 to 2024. Results In 2024, 27.8% of the Czech population met criteria for Stage A HF and 8.2% for Stage B. Over 10 years, the prevalence of both preclinical stages increased beyond what could be explained by population aging alone, with age-standardized prevalence rising by 9.5% for Stage A and 19.2% for Stage B. Age-standardized 1-year mortality showed a steep stepwise gradient, from 0.69% in Stage A to 1.69% in Stage B, 3.06% in Stage C, and 7.27% in Stage D. Among 52,172 individuals with incident clinical HF in 2024, more than 95% had previously met administrative criteria for Stage A or Stage B. Conclusion Administrative surveillance of the HF continuum using routinely collected healthcare data provides a scalable administrative framework for population-level monitoring of HF burden. In Czechia, both preclinical and clinical HF burdens increased over time beyond population aging alone, underscoring the need for earlier preventive strategies targeting preclinical disease. Clinical Perspective We developed a nationwide administrative-data algorithm that classifies the full heart failure continuum (Stages A–D) using routinely collected ICD-10 diagnoses, prescription claims, and procedure codes, showing that both preclinical and clinical HF burdens are rising beyond what population aging explains. More than 95% of individuals who developed clinical HF had previously met administrative criteria for Stage A or Stage B, suggesting that progression to overt disease is often preceded by an identifiable preclinical phase that may represent an opportunity for prevention. This scalable, low-cost surveillance framework enables health systems to identify at-risk populations, track HF trends over time, and target preventive strategies toward preclinical stages, an approach that could be adapted internationally to inform policy and resource allocation. Graphical abstract Conclusion: A population-wide HF staging system based on administrative data enables surveillance of the HF epidemic. In Czechia, the burden of preclinical and clinical HF is increasing.

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