Predictors of incident heart failure in a large insured population: a one million person-year follow-up study.
BACKGROUND
Studies on the incidence and predictors of heart failure (HF) are often restricted to elderly persons or identify only inpatient cases.


RESULTS
We determined the incidence and predictors of new HF diagnosed in either outpatient or inpatient settings, among 359 947 women and men (age ≥18 years) insured by Kaiser Permanente Georgia at any time during calendar years 2000 to 2005. Subjects were free of HF at baseline, and incident HF was identified with ICD-9 codes (1 inpatient or 2 outpatient HF visits). We developed multivariable Cox models to assess the association of antecedent factors (coronary heart disease, hypertension, diabetes mellitus, atrial fibrillation, and valvular heart disease) with incident HF. Separate models were created for each sex and for newly diagnosed HF in outpatient or inpatient settings. There were 4001 incident HF cases (50% women and 48% in subjects <65 years old), during 1 015 794 person-years of follow-up. The incidence rate of HF was greater in men than in women (4.24 versus 3.68 per 1000 person-years) but was stable across the study interval in both sexes. Two thirds of incident HF cases from this population occurred in outpatients. These 5 antecedent factors and age yielded excellent discrimination for incident HF in both outpatients and inpatients and in both sexes (C >0.85 in all models).


CONCLUSIONS
Common modifiable risk factors accurately discriminate women and men at risk for HF diagnosed in either outpatient or inpatient settings. Approximately two thirds of new HF cases in our insured population were diagnosed in outpatients; more research is needed to characterize these subjects and their prognosis.
Goyal
Abhinav
A
Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA. AGOYAL4@EMORY.EDU
Norton
Catherine R
CR
Thomas
Tracy N
TN
Davis
Robert L
RL
Butler
Javed
J
Ashok
Varun
V
Zhao
Liping
L
Vaccarino
Viola
V
Wilson
Peter W F
PW
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications; D048909:Diabetes Complications; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D015994:Incidence; D007348:Insurance, Health; D008297:Male; D008875:Middle Aged; D010045:Outpatients / Q000706:statistics & numerical data; D015995:Prevalence; D016016:Proportional Hazards Models; D012307:Risk Factors; D017678:Sex Distribution; D055815:Young Adult
N Engl J Med. 2002 Oct 31;347(18):1397-402
12409541
Arch Intern Med. 2001 Apr 9;161(7):996-1002
11295963
Am J Med. 2009 Nov;122(11):1023-8
19854330
Circulation. 2002 Dec 10;106(24):3068-72
12473553
JAMA. 2004 Jul 21;292(3):344-50
15265849
J Am Coll Cardiol. 2000 May;35(6):1628-37
10807470
Circ Heart Fail. 2008 Nov;1(4):242-8
19808298
N Engl J Med. 2009 Mar 19;360(12):1179-90
19297571
Arch Intern Med. 2008 Feb 25;168(4):418-24
18299498
Circulation. 2004 Sep 14;110(11):1424-30
15353499
Circulation. 2006 Feb 14;113(6):799-805
16461823
J Intern Med. 2001 Mar;249(3):253-61
11285045
Circulation. 2008 May 13;117(19):2544-65
18391114
Circ Heart Fail. 2008 Jul;1(2):125-33
19777072
N Engl J Med. 2009 Aug 27;361(9):878-87
19710486
Arch Intern Med. 1999 Jun 14;159(11):1197-204
10371227
Circulation. 2001 Jun 5;103(22):2668-73
11390335
Am J Med. 1999 Jun;106(6):605-12
10378616