JACC Vol. 62, No. 16, 2013 Yancy et al. October 15, 2013:1495 539 2013 ACCF/AHA Heart Failure Guidelines: Executive Summary prevalence continues to rise (40). In the Medicare-eligible population, HF prevalence increased from 90 to 121 per HFpEF each make up about half of the overall HF burden (43). One in 5 Americans will be >65 years of age by 2050 (44). Because HF prevalence is highest in this group, the number of Americans with HF is expected to signi cantly worsen in the future. Disparities in the epidemiology of HF have been identi ed. Blacks have the highest risk for HF (45). In the ARIC (Atherosclerosis Risk in Communities) study, incidence rate per 1,000 person-years was lowest among white women, (41,42) and highest among black men, (46) with blacks having a greater 5-year mortality rate than whites (47). HF in non-Hispanic black males and females has a prevalence of 4.5% and 3.8%, respectively, versus 2.7% and 1.8% in non-Hispanic white males and females, respectively (40). 5. Initial and Serial Evaluation of the HF Patient: Recommendations 5.1. Clinical Evaluation See Table 5 for multivariable clinical risk scores. 5.1.1. History and Physical Examination CLASS I 1. A thorough history and physical examination should be ob- tained/performed in patients presenting with HF to identify cardiac and noncardiac disorders or behaviors that might cause or accelerate the development or progression of HF. (Level of Evidence: C) 2. In patients with idiopathic dilated cardiomyopathy, a 3- generational family history should be obtained to aid in establishing the diagnosis of familial dilated cardiomyop- athy. (Level of Evidence: C) Table 3. Definitions of HFrEF and HFpEF Classification EF (%) Description I. Heart failure with reduced ejection fraction (HFrEF) 40 Also referred to as systolic HF. 