Risk factors and prediction models for incident heart failure with reduced and preserved ejection fraction

Abstract

AimsThis study aims to develop the first race-specific and sex-specific risk prediction models for heart failure with preserved (HFpEF) and reduced ejection fraction (HFrEF). Methods and resultsWe created a cohort of 1.8 million individuals who had an outpatient clinic visit between 2002 and 2007 within the Veterans Affairs (VA) Healthcare System and obtained information on HFpEF, HFrEF, and several risk factors from electronic health records (EHR). Variables were selected for the risk prediction models in a 'derivation cohort' that consisted of individuals with baseline date in 2002, 2003, or 2004 using a forward stepwise selection based on a change in C-index threshold. Discrimination and calibration were assessed in the remaining participants (internal 'validation cohort'). A total of 66 831 individuals developed HFpEF, and 92 233 developed HFrEF (52 679 and 71 463 in the derivation cohort) over a median of 11.1 years of follow-up. The HFpEF risk prediction model included age, diabetes, BMI, COPD, previous MI, antihypertensive treatment, SBP, smoking status, atrial fibrillation, and estimated glomerular filtration rate (eGFR), while the HFrEF model additionally included previous CAD. For the HFpEF model, C-indices were 0.74 (SE = 0.002) for white men, 0.76 (0.005) for black men, 0.79 (0.015) for white women, and 0.77 (0.026) for black women, compared with 0.72 (0.002), 0.72 (0.004), 0.77 (0.017), and 0.75 (0.028), respectively, for the HFrEF model. These risk prediction models were generally well calibrated in each race-specific and sex-specific stratum of the validation cohort. Conclusions Our race-specific and sex-specific risk prediction models, which used easily obtainable clinical variables, can be a useful tool to implement preventive strategies or subtype-specific prevention trials in the nine million users of the VA healthcare system and the general population after external validation.

Novel biomarkers of inflammation in heart failure with preserved ejection fraction: analysis from a large prospective cohort study

“…While the present study did not evaluate the direct roles of oxLDL-C, previous reports have assessed the relation of LDL-C and HFpEF [ 17 ]. Moreover, prior reports have investigated the relation between heart failure and HDL-C and LDL-C [ 18 ]. Therefore, while correlation likely exists between HDL-C/LDL-C overall, the present analysis was primarily assessing linkage between inflammation and HFpEF.…”

A year in heart failure: updates of clinical and preclinical findings

“…The first race‐specific and sex‐specific risk prediction model, based on easily obtainable clinical variables, was recently presented as potentially useful tool to implement preventive strategies. The risk prediction model for HFpEF included age, diabetes, higher body mass index, chronic obstructive pulmonary disease, previous myocardial infarction (MI), antihypertensive treatment, systolic pressure, smoking status, atrial fibrillation, and estimated glomerular filtration rate (eGFR), while the HFrEF model additionally included previous coronary artery disease 2 …”

Genetic architecture of heart failure with preserved versus reduced ejection fraction

“…In the algorithm for identification of HF patients, we used documentation in EHR of the ordering of B-type natriuretic peptide as one of the criteria, since evaluation of practice patterns indicated that ordering of B-type natriuretic peptide increased the likelihood of the patient having clinical HF, as validated by blinded review 42 . For this study, to increase the number of HFpEF patients included in the study, we utilized a less restrictive definition recently utilized in a study 44 that did not require that all LVEFs recorded after the baseline measurement also be ≥50%, or the use of diuretics and/or measurement of B-type natriuretic peptide at baseline (Fig. 2).…”