The diagnosis of heart failure in the community

Abstract

OBJECTIVES We sought to compare construct and predictive validity of four sets of heart failure (HF) diagnostic criteria in an epidemiologic setting. BACKGROUND The prevalence estimates of HF vary broadly depending on the diagnostic criteria. METHODS Data were collected in a survey of community dwellers who were 65 years of age living in Dicomano, Italy. At baseline, HF was diagnosed with the criteria of the Framingham, Boston, and Gothenburg studies and of the European Society of Cardiology (ESC). Left ventricular mass index and ejection fraction, left atrium systolic dimension, lower extremity mobility disability, summary physical performance score, and 6-min walk test were compared between HF and non-HF participants to test for construct validity of each set of criteria. Predictive validity was evaluated with follow-up assessment of cardiovascular mortality, incident disability, and HF-related hospitalizations. Comparisons were adjusted for demo-graphics, comorbidity, and psychoaffective status. RESULTS Of 553 participants, 11.9%, 10.7%, 20.8%, and 9.0% had HF, according to Framingham, Boston, Gothenburg, and ESC criteria, respectively. In terms of construct validity, Framingham and Boston criteria discriminated HF from non-HF participants better than Gothenburg and ESC criteria across the measures of cardiac function and global performance. The Boston criteria showed a superior predictive validity because they indicated a significantly greater adjusted risk of cardiovascular death (hazard ratio 3.9, 95% confidence interval 1.2 to 13.2), incident disability, and hospitalizations in participants with HF. CONCLUSIONS The Boston criteria are preferable to Framingham, Gothenburg, and ESC criteria for the diagnosis of HF in older community dwellers because they have good construct validity and more accurately predict cardiovascular death, incident disability, and hospitalizations. (J Am

Classification of Heart Failure in the Atherosclerosis Risk in Communities (ARIC) Study

“…Substantial concordance among the MBS FRM, NHANES schemes (kappa coefficients generally > 0.60) have been reported 27, 30 , but agreement between GTH and the others are poor. Our findings of poor agreement among criteria are supported by previous work comparing FRM criteria, European Society of Cardiology (ESC) criteria and independent physician review 11 .…”

Understanding the Epidemic of Heart Failure: Past, Present, and Future

“…[8] HF was diagnosed in 11.9%, 10.7%, 20.8%, and 9.0% of participants using the Framingham, Boston, Gothenburg, and ESC criteria, respectively. The Boston criteria best predicted adverse cardiovascular events, including cardiovascular death and HF-related hospitalization, and are therefore recommended for use in older adults.…”

Prevalence and risk factors of heart failure in the USA: NHANES 2013 – 2014 epidemiological follow-up study

“…Due to the nature of the disease process, multiple diagnostic criteria have arisen, the most notable being those based on the Framingham Heart Study [3]. Other noteworthy criteria include those based on the Cardiovascular Health Study (CHS) or the European Society of Cardiology [4]. …”