Survival Associated with Two Sets of Diagnostic Criteria for Congestive Heart Failure

Abstract

Congestive heart failure (CHF) definitions vary across epidemiologic studies. The Framingham Heart Study criteria include CHF signs and symptoms assessed by a physician panel. In the Cardiovascular Health Study, a committee of physicians adjudicated CHF diagnoses, confirmed by signs, symptoms, clinical tests, and/or medical therapy. The authors used data from the Cardiovascular Health Study, a population-based cohort study of 5,888 elderly US adults, to compare CHF incidence and survival patterns following onset of CHF as defined by Framingham and/or Cardiovascular Health Study criteria. They constructed an inception cohort of nonfatal, hospitalized CHF patients. Of 875 participants who had qualifying CHF hospitalizations between 1989 and 2000, 54% experienced a first CHF event that fulfilled both sets of diagnostic criteria (concordant), 31% fulfilled only the Framingham criteria (Framingham only), and 15% fulfilled only the Cardiovascular Health Study criteria (Cardiovascular Health Study only). No significant survival difference was found between the Framingham-only group (hazard ratio = 0.87, 95% confidence interval: 0.71, 1.07) or the Cardiovascular Health Study-only group (hazard ratio = 0.89, 95% confidence interval: 0.68, 1.15) and the concordant group (referent). Compared with Cardiovascular Health Study central adjudication, Framingham criteria for CHF identified a larger group of participants with incident CHF, but all-cause mortality rates were similar across these diagnostic classifications.

High insulinlike growth factor binding protein 1 level predicts incident congestive heart failure in the elderly

“…We did not replicate that study's findings of increased CHF risk among older adults with low IGF-I (relative risk ~ 2 comparing below versus above the median IGF-I level, and relative risk ~ 2.5 comparing below versus above the 10 th percentile IGF-I level). Compared with the prior report from Framingham, the present study had important methodological differences including larger sample size (n=566 vs 56 CHF cases), availability of fasting blood specimens, and a different CHF case definition (27). The only other prospective epidemiological study in this area suggested that a CA repeat in the IGF1 promoter region was overrepresented among CHF cases as compared with population-based controls (46), although the functional relevance of this genetic variant is unconfirmed (47) and serum IGF-I levels were unavailable.…”

“…CHF was defined as a constellation of symptoms including shortness of breath, fatigue, orthopnea and paroxysmal nocturnal dyspnea and physical signs including edema, rales, tachycardia, a gallop rhythm and a displaced LV apical impulse. Criteria used to validate CHF diagnoses were: cardiomegaly and pulmonary edema on chest X-ray, evidence of a dilated ventricle, and global or segmental wall-motion abnormalities with decreased systolic function either by echocardiography or contrast ventriculography (27,28). Criteria required that the participant was treated medically for CHF.…”

Usefulness of Quantitative Assessment of Electrocardiographic ST Depression for Predicting New-Onset Heart Failure in American Indians (from the Strong Heart Study)

“…Development of heart failure was a prespecified endpoint in the Strong Heart Study (3), with the diagnosis of heart failure made using clinical and diagnostic findings based on Framingham criteria (6). Each case was reviewed and verified by investigators who were blinded to ECG STD results when classifying possible morbid events (3).…”

Vitamin D plus calcium supplementation among postmenopausal women : effect on risk of heart failure in the Women's Health Initiative.

“…Notwithstanding these shortcomings, the study highlights the importance of central adjudication of HF cases for epidemiologic studies. In summary, there is no current "gold standard" for identifying incident HF cases with minimum misclassification bias, central adjudication by a committee is essential for assessing HF in epidemiological studies (37)(38)(39)(40).…”

“…However, hospital discharge data are influenced by reimbursement codes as well as inconsistencies in coding practices (41 (38). In summary, there is no current "gold standard" for identifying incident HF cases with minimum misclassification 9 bias, central adjudication by a committee is essential for population studies because this method has a relatively higher specificity (37)(38)(39)(40)42). …”