title: Survival associated with two sets of diagnostic criteria for congestive heart failure.
abstract: Congestive heart failure (CHF) definitions vary across epidemiologic studies. The Framingham Heart Study criteria include CHF signs and symptoms assessed by a physician panel. In the Cardiovascular Health Study, a committee of physicians adjudicated CHF diagnoses, confirmed by signs, symptoms, clinical tests, and/or medical therapy. The authors used data from the Cardiovascular Health Study, a population-based cohort study of 5,888 elderly US adults, to compare CHF incidence and survival patterns following onset of CHF as defined by Framingham and/or Cardiovascular Health Study criteria. They constructed an inception cohort of nonfatal, hospitalized CHF patients. Of 875 participants who had qualifying CHF hospitalizations between 1989 and 2000, 54% experienced a first CHF event that fulfilled both sets of diagnostic criteria (concordant), 31% fulfilled only the Framingham criteria (Framingham only), and 15% fulfilled only the Cardiovascular Health Study criteria (Cardiovascular Health Study only). No significant survival difference was found between the Framingham-only group (hazard ratio = 0.87, 95% confidence interval: 0.71, 1.07) or the Cardiovascular Health Study-only group (hazard ratio = 0.89, 95% confidence interval: 0.68, 1.15) and the concordant group (referent). Compared with Cardiovascular Health Study central adjudication, Framingham criteria for CHF identified a larger group of participants with incident CHF, but all-cause mortality rates were similar across these diagnostic classifications.
authors.affiliation: Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA, USA. ginas@u.washington.edu
authors.forename: Gina D
authors.initials: GD
authors.lastname: Schellenbaum
authors.forename: Thomas D
authors.initials: TD
authors.lastname: Rea
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Nicholas L
authors.initials: NL
authors.lastname: Smith
authors.forename: Thomas
authors.initials: T
authors.lastname: Lumley
authors.forename: Veronique L
authors.initials: VL
authors.lastname: Roger
authors.forename: Dalane W
authors.initials: DW
authors.lastname: Kitzman
authors.forename: Herman A
authors.initials: HA
authors.lastname: Taylor
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: Bruce M
authors.initials: BM
authors.lastname: Psaty
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003937:Diagnosis, Differential; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000145:classification* / Q000453:epidemiology / Q000401:mortality*; D006801:Humans; D015994:Incidence; D008297:Male; D011379:Prognosis; D012720:Severity of Illness Index; D016019:Survival Analysis