title: Prediction of incident heart failure in general practice: the Atherosclerosis Risk in Communities (ARIC) Study.
abstract: BACKGROUND
  A simple and effective heart failure (HF) risk score would facilitate the primary prevention and early diagnosis of HF in general practice. We examined the external validity of existing HF risk scores, optimized a 10-year HF risk function, and examined the incremental value of several biomarkers, including N-terminal pro-brain natriuretic peptide.
  
  
  RESULTS
  During 15.5 years (210 102 person-years of follow-up), 1487 HF events were recorded among 13 555 members of the biethnic Atherosclerosis Risk in Communities (ARIC) Study cohort. The area under curve from the Framingham-published, Framingham-recalibrated, Health ABC HF recalibrated, and ARIC risk scores were 0.610, 0.762, 0.783, and 0.797, respectively. On addition of N-terminal pro-brain natriuretic peptide, the optimism-corrected area under curve of the ARIC HF risk score increased from 0.773 (95% CI, 0.753-0.787) to 0.805 (95% CI, 0.792-0.820). Inclusion of N-terminal pro-brain natriuretic peptide improved the overall classification of recalibrated Framingham, recalibrated Health ABC, and ARIC risk scores by 18%, 12%, and 13%, respectively. In contrast, cystatin C or high-sensitivity C-reactive protein did not add toward incremental risk prediction.
  
  
  CONCLUSIONS
  The ARIC HF risk score is more parsimonious yet performs slightly better than the extant risk scores in predicting 10-year risk of incident HF. The inclusion of N-terminal pro-brain natriuretic peptide markedly improves HF risk prediction. A simplified risk score restricted to a patient's age, race, sex, and N-terminal pro-brain natriuretic peptide performs comparably to the full score (area under curve, 0.745) and is suitable for automated reporting from laboratory panels and electronic medical records.
authors.affiliation: Departments of Epidemiology and Biostatistics, University of North Carolina, Chapel Hill, NC 27514, USA.
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: Lloyd E
authors.initials: LE
authors.lastname: Chambless
authors.forename: Christie M
authors.initials: CM
authors.lastname: Ballantyne
authors.forename: Brad
authors.initials: B
authors.lastname: Astor
authors.forename: Alain G
authors.initials: AG
authors.lastname: Bertoni
authors.forename: Patricia P
authors.initials: PP
authors.lastname: Chang
authors.forename: Aaron R
authors.initials: AR
authors.lastname: Folsom
authors.forename: Max
authors.initials: M
authors.lastname: He
authors.forename: Ron C
authors.initials: RC
authors.lastname: Hoogeveen
authors.forename: Hanyu
authors.initials: H
authors.lastname: Ni
authors.forename: Pedro M
authors.initials: PM
authors.lastname: Quibrera
authors.forename: Wayne D
authors.initials: WD
authors.lastname: Rosamond
authors.forename: Stuart D
authors.initials: SD
authors.lastname: Russell
authors.forename: Eyal
authors.initials: E
authors.lastname: Shahar
authors.forename: Gerardo
authors.initials: G
authors.lastname: Heiss
mesh_terms: D000367:Age Factors; D019540:Area Under Curve; D050197:Atherosclerosis / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000032:analysis; D016009:Chi-Square Distribution; D055316:Cystatin C / Q000097:blood; D005260:Female; D058006:General Practice / Q000706:statistics & numerical data*; D006305:Health Status Indicators; D006333:Heart Failure / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D006801:Humans; D015994:Incidence; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D044469:Racial Groups; D015203:Reproducibility of Results; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D013997:Time Factors; D014481:United States / Q000453:epidemiology
chemical_list: D015415:Biomarkers; C525030:CST3 protein, human; D055316:Cystatin C; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein