Left ventricular dysfunction as a risk factor for cardiovascular and noncardiovascular hospitalizations in African Americans.
BACKGROUND
A substantial portion of the public health burden of heart failure is due to hospitalizations, many of which are for causes other than cardiovascular disease. We assessed whether left ventricular (LV) systolic dysfunction was associated with increased risk of both cardiovascular and noncardiovascular hospitalizations in a community sample of African Americans.


METHODS
African American participants from the Jackson, MS, site of the Atherosclerosis Risk in Communities (ARIC) study who underwent echocardiography were followed for 12 years. Hospitalization rates among individuals with and without LV systolic dysfunction were compared using negative binomial regression.


RESULTS
Among 2,416 participants with echocardiograms, LV systolic dysfunction was found in 61 (2.5%). Participants with LV dysfunction experienced 366 hospitalizations, a rate of 1.27 per person-year, compared with 0.25 per person-year among individuals without LV dysfunction. The incidence rate ratio adjusted for demographics, comorbidities, and other risk factors was 3.11 (95% CI 2.22-4.35). The adjusted rate ratios were 4.76 (95% CI 2.90-7.20) for cardiovascular and 2.67 (95% CI 1.82-3.90) for noncardiovascular diagnoses, with similar findings in the subset of individuals with asymptomatic LV dysfunction. The percentage attributable risks for hospitalizations were 87% and 74% for cardiovascular and noncardiovascular causes (79% and 63% after adjustment).


CONCLUSIONS
African American individuals with LV dysfunction are at an increased risk of hospitalization due to a wide range of causes, with noncardiovascular hospitalizations accounting for nearly half the increased risk. To the extent that estimates of risk focus on cardiovascular morbidity, they may underestimate the true health burden of LV dysfunction.
Blecker
Saul
S
Johns Hopkins University School of Medicine, Baltimore, MD, USA. sblecker@jhmi.edu
Matsushita
Kunihiro
K
Fox
Ervin
E
Russell
Stuart D
SD
Miller
Edgar R
ER
Taylor
Herman
H
Brancati
Frederick
F
Coresh
Josef
J
D001741:Black or African American; D015897:Comorbidity; D003925:Diabetic Angiopathies / Q000453:epidemiology; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008922:Mississippi / Q000453:epidemiology; D029424:Pulmonary Disease, Chronic Obstructive / Q000453:epidemiology; D012307:Risk Factors; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000401:mortality
Am J Epidemiol. 1989 Apr;129(4):687-702
2646917
Circulation. 1981 Oct;64(4):744-53
7273375
JAMA. 2003 Jan 8;289(2):194-202
12517230
Echocardiography. 2003 Feb;20(2):111-20
12848675
Ann Intern Med. 2006 Aug 15;145(4):247-54
16908915
J Am Coll Cardiol. 2007 Aug 21;50(8):768-77
17707182
J Am Coll Cardiol. 2008 Aug 5;52(6):428-34
18672162
Circulation. 2009 Jan 27;119(3):e21-181
19075105
Eur J Heart Fail. 2004 Aug;6(5):653-61
15302015
J Am Coll Cardiol. 2003 May 7;41(9):1510-8
12742291
Circulation. 2003 Aug 26;108(8):977-82
12912813
Eur Heart J. 1998 Jun;19(6):842-6
9651707
Eur Heart J. 1998 Dec;19 Suppl P:P9-16
9886707
N Engl J Med. 1992 Sep 3;327(10):685-91
1463530
Eur Heart J. 1987 Sep;8(9):1007-14
3665952
Biometrics. 1993 Sep;49(3):865-72
8241375
Hypertension. 2003 Nov;42(5):1050-65
14604997
N Engl J Med. 1992 Sep 3;327(10):669-77
1386652
Eur Heart J. 2005 Nov;26(22):2368-74
15980032
Lancet. 2001 Aug 11;358(9280):439-44
11513906
Am Heart J. 2007 Feb;153(2):238-44
17239683
J Am Coll Cardiol. 1997 Feb;29(2):229-36
9014971
J Am Soc Nephrol. 2007 Apr;18(4):1307-15
17344421
J Am Coll Cardiol. 2009 Oct 27;54(18):1695-702
19850209
Eur Heart J. 1989 Aug;10 Suppl C:13-8
2806286
Circulation. 2009 Apr 14;119(14):1977-2016
19324967
Clin Cardiol. 2003 Sep;26(9):411-8
14524597
Clin Cardiol. 2009 Jan;32(1):47-52
19143005
Am Heart J. 2005 Sep;150(3):448-54
16169322
Am Heart J. 2007 Jun;153(6):1074-80
17540212
N Engl J Med. 2006 Jul 20;355(3):260-9
16855266
Pharmacoeconomics. 2008;26(6):447-62
18489197
Eur Heart J. 2006 Jan;27(2):193-200
16267076
Ann Intern Med. 2003 Jun 3;138(11):907-16
12779301
Natl Vital Stat Rep. 2001 May 18;49(2):1-32
11381674
J Am Coll Cardiol. 2007 Jan 16;49(2):171-80
17222727
Am J Cardiol. 1992 Nov 1;70(13):1180-4
1414943
Arch Intern Med. 2008 Dec 8;168(22):2481-8
19064833
N Engl J Med. 1995 Dec 21;333(25):1670-6
7477219