Rheumatic heart disease and risk of incident heart failure among community-dwelling older adults: a prospective cohort study.
BACKGROUND
Little is known about the association of rheumatic heart disease (RHD) with incident heart failure (HF) among older adults.


METHODS
Cardiovascular Health Study, a prospective cohort study.


METHODS
Of the 4,751 community-dwelling adults ≥ 65 years, free of prevalent HF at baseline, 140 had RHD, defined as self-reported physician-diagnosed RHD along with echocardiographic evidence of left-sided valvular disease. Propensity scores for RHD, estimated for each of the 4,751 participants, were used to assemble a cohort of 720, in which 124 and 596 participants with and without RHD, respectively, were balanced on 62 baseline characteristics.


RESULTS
Incident HF developed in 33% and 22% of matched participants with and without RHD, respectively, during 13 years of follow-up (hazard ratio when RHD was compared to no-RHD 1.60; 95% confidence interval 1.13-2.28; P = 0.008). Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for RHD-associated incident heart failure were 2.04 (1.54-2.71; P < 0.001), 1.32 (1.02-1.70; P = 0.034), and 1.55 (1.14-2.11; P = 0.005), respectively. RHD was not associated with all-cause mortality (HR 1.09; 95% CI 0.82-1.45; P = 0.568).


CONCLUSIONS
RHD is an independent risk factor for incident HF among community-dwelling older adults free of HF, but has no association with mortality.
University of Alabama at Birmingham, USA.
Marjan
M
Mujib
Ravi V
RV
Desai
Mustafa I
MI
Ahmed
Jason L
JL
Guichard
Margaret A
MA
Feller
O James
OJ
Ekundayo
Prakash
P
Deedwania
Mahboob
M
Ali
Inmaculada B
IB
Aban
Thomas E
TE
Love
Michel
M
White
Wilbert S
WS
Aronow
Shahbudin H
SH
Rahimtoola
Robert O
RO
Bonow
Ali
A
Ahmed
D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology / Q000209:etiology*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D057216:Propensity Score; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012214:Rheumatic Heart Disease / Q000150:complications*; D012306:Risk; D012307:Risk Factors
Am J Cardiol. 2007 Feb 1;99(3):393-8
17261405
N Engl J Med. 2007 Aug 2;357(5):470-6
17671255
Ann Epidemiol. 1991 Feb;1(3):263-76
1669507
Eur Heart J. 2006 Jan;27(2):178-86
16339157
J Am Coll Cardiol. 2008 Sep 23;52(13):e1-142
18848134
Ann Epidemiol. 1995 Jul;5(4):270-7
8520708
Am Heart J. 2006 Nov;152(5):956-66
17070167
J Am Coll Cardiol. 2000 May;35(6):1628-37
10807470
Circulation. 2006 Aug 1;114(5):422-9
16864725
Eur Heart J. 2007 Jun;28(11):1334-43
17537738
Eur Heart J. 1993 Jan;14(1):122-8
8432279
J Am Coll Cardiol. 2007 Oct 23;50(17):1688-93
17950152
Lancet Infect Dis. 2005 Nov;5(11):685-94
16253886
Heart. 2001 Aug;86(2):127
11454820
Circulation. 1995 Nov 1;92(9 Suppl):II458-66
7586455
Stat Med. 1998 Oct 15;17(19):2265-81
9802183
J Clin Epidemiol. 2001 Apr;54(4):387-98
11297888
Circulation. 1971 Sep;44(3):368-80
4255488
Hypertension. 2009 Mar;53(3):458-65
19188527
Eur Heart J. 2006 Jun;27(12):1431-9
16709595
Lancet. 2009 Apr 18;373(9672):1382-94
19356795
J Heart Valve Dis. 2004 Sep;13(5):741-6
15473473
Nutrition. 2006 May;22(5):581-3
16600821
N Engl J Med. 2007 Aug 2;357(5):439-41
17671252
Am J Epidemiol. 1999 Aug 15;150(4):341-53
10453810
JAMA. 1992 Sep 9;268(10):1287-91
1387172
Heart. 2007 Dec;93(12):1584-90
17488764
Ann Intern Med. 1964 Feb;60:SUPPL 5:87-123
14118551