Abstract 834: Predictors of New-Onset Heart Failure in a Large Insured Population: A One Million Person-Years Follow-up Study
Background: Heart failure (HF) is a leading cause of morbidity in the elderly. However, few studies have described risk factors for incident HF in a population with both younger and older adults, or have provided sex-specific estimates of HF risk.
Methods: We analyzed electronic medical records from 191,401 women and 168,547 men (≥18 years old) enrolled in Kaiser Permanente Georgia at any time during the calendar years 2000 –2005. Patients were included only if they were Kaiser members for at least one year before the study period and were free of HF at baseline. One inpatient or two outpatient visits with an ICD-9 code for HF were used to diagnose HF, and ICD-9 codes were also used to document the following risk factors present before incident HF: hypertension (HTN), diabetes mellitus (DM), coronary artery disease (CAD), atrial fibrillation (AF), and valvular heart disease. Multivariable logistic regression with repeated measures was used to assess the odds of incident HF associated with each of these antecedent risk factors.
Results: There were 4,001 new HF cases (50% women; 48% in subjects <65 yrs old), during 1,015,794 person-yrs of follow-up. HF incidence was higher in men than in women for each age group (Table 1⇓). Among women with incident HF, the mean (± SD) age at diagnosis was 65.2±15.3 years, and 83% had ≥1 risk factor before HF diagnosis: 80% had HTN; 31% DM; 18% CAD; 8% AF; and 9% valvular disease. Among men with new HF, the mean age was 62.6±13.3 years, and 80% had ≥1 HF risk factor: 76% had HTN; 32% DM; 27% CAD; 10% AF; and 9% valvular disease. These five risk factors (plus age) were strong HF predictors and yielded good discrimination (C index almost 0.9) for incident HF in both sexes (Table 2⇓).
Conclusions: In both women and men, a set of common, modifiable risk factors accurately discriminate persons at increased risk for developing new-onset HF. Population-based approaches for preventing and treating these risk factors are critical for reducing the societal burden of HF.