title: Predictors of incident heart failure in a large insured population: a one million person-year follow-up study.
abstract: 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.
authors.affiliation: Emory Rollins School of Public Health, 1518 Clifton Road NE, Atlanta, GA 30322, USA. AGOYAL4@EMORY.EDU
authors.forename: Abhinav
authors.initials: A
authors.lastname: Goyal
authors.forename: Catherine R
authors.initials: CR
authors.lastname: Norton
authors.forename: Tracy N
authors.initials: TN
authors.lastname: Thomas
authors.forename: Robert L
authors.initials: RL
authors.lastname: Davis
authors.forename: Javed
authors.initials: J
authors.lastname: Butler
authors.forename: Varun
authors.initials: V
authors.lastname: Ashok
authors.forename: Liping
authors.initials: L
authors.lastname: Zhao
authors.forename: Viola
authors.initials: V
authors.lastname: Vaccarino
authors.forename: Peter W F
authors.initials: PW
authors.lastname: Wilson
mesh_terms: 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
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