Abstract 1453: History of Rheumatic Heart Disease and Increased Risk of Incident Heart Failure Among Older Adults: A Propensity-Matched Study of a Prospective Population Cohort
Background: Rheumatic heart disease (RHD) is the leading cause of cardiovascular (CV) morbidity and mortality among the population <50 yrs in developing nations. However, little is known about the association between RHD and incident heart failure (HF) among those ≥65 yrs. We tested the hypothesis that RHD is associated with increased incident HF among community-dwelling older adults.
Methods: Of the 5795 Cardiovascular Health Study participants ≥65 yrs, 5521 were without baseline HF, of which 5386 had data on RHD and 284 had baseline RHD. Data on self-reported physician-diagnosed CV morbidity including RHD was collected at baseline. Propensity scores for RHD, estimated for each subject, were used to match 267 and 1299 subjects with and without RHD, using a 1 up to 5 greedy matching protocol. Matched subjects (n=1566) with and without RHD were balanced on 64 baseline characteristics. Matched Cox regression models were used to estimate the association of RHD with incident HF during a mean follow-up of 10 years.
Results: Subjects had a mean age of 72 (±5) years, 67% were women, 11% were African Americans and 22% developed incident HF. Incident HF developed in 27% (rate, 294/10000 person-yrs) and 20% (rate, 213/10000 person-yrs) of subjects with and without RHD, respectively (matched hazard ratio (HR) when RHD was compared with no-RHD, 1.34; 95% CI, 1.01–1.77; P=0.041; Figure⇓). Pre-match unadjusted, multivariable-adjusted and propensity-adjusted HR (95% CI) for RHD-associated incident HF were 1.52 (1.21–1.90; P<0.0001), 1.33 (1.05–1.69; P=0.018) and 1.32 (1.04 –1.66; P=0.021) respectively.
Conclusion: Among community-dwelling older adults, RHD increased the risk of incident HF.