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Reduction of the monetary and societal costs of the heart failure epidemic can best be achieved by prevention of new heart failure cases. To effectively prevent heart failure, patients at risk must be identified and treated. The American College of Cardiology/American Heart Association Guidelines for Evaluation and Management of Chronic Heart Failure in the Adult define the stage A heart failure patient as one with identified risk factors for heart failure, particularly coronary heart disease, hypertension, and diabetes, but no evidence of cardiovascular damage. In this review, the authors discuss the commonly recognized, as well as some less commonly recognized, risk factors that define the stage A patient. The authors also discuss data demonstrating that risk factor modification can reduce heart failure incidence. Given the size of the population at risk, through increased awareness of heart failure risk and aggressive treatment, health care providers can critically impact this public health concern.