Predictors of incident heart failure in a large insured population

A one million person-year follow-up study

Abhinav Goyal, Catherine R. Norton, Tracy N. Thomas, Robert Davis, Javed Butler, Varun Ashok, Liping Zhao, Viola Vaccarino, Peter W.F. Wilson

Research output: Contribution to journalArticle

41 Citations (Scopus)

Abstract

Background - Studies on the incidence and predictors of heart failure (HF) are often restricted to elderly persons or identify only inpatient cases. Methods and Results - We determined the incidence and predictors of new HF diagnosed in either outpatient or inpatient settings, among 359 947 women and men (age ≥18 years) insured by Kaiser Permanente Georgia at any time during calendar years 2000 to 2005. Subjects were free of HF at baseline, and incident HF was identified with ICD-9 codes (1 inpatient or 2 outpatient HF visits). We developed multivariable Cox models to assess the association of antecedent factors (coronary heart disease, hypertension, diabetes mellitus, atrial fibrillation, and valvular heart disease) with incident HF. Separate models were created for each sex and for newly diagnosed HF in outpatient or inpatient settings. There were 4001 incident HF cases (50% women and 48% in subjects <65 years old), during 1 015 794 person-years of follow-up. The incidence rate of HF was greater in men than in women (4.24 versus 3.68 per 1000 person-years) but was stable across the study interval in both sexes. Two thirds of incident HF cases from this population occurred in outpatients. These 5 antecedent factors and age yielded excellent discrimination for incident HF in both outpatients and inpatients and in both sexes (C >0.85 in all models). Conclusions - Common modifiable risk factors accurately discriminate women and men at risk for HF diagnosed in either outpatient or inpatient settings. Approximately two thirds of new HF cases in our insured population were diagnosed in outpatients; more research is needed to characterize these subjects and their prognosis. (Circ Heart Fail. 2010;3:698-705.).

Original languageEnglish (US)
Pages (from-to)698-705
Number of pages8
JournalCirculation: Heart Failure
Volume3
Issue number6
DOIs
StatePublished - Nov 1 2010

Fingerprint

Heart Failure
Population
Inpatients
Outpatients
International Classification of Diseases
Heart Valve Diseases
Proportional Hazards Models
Atrial Fibrillation
Coronary Disease
Diabetes Mellitus
Cohort Studies
Hypertension
Incidence
Research

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine

Cite this

Predictors of incident heart failure in a large insured population : A one million person-year follow-up study. / Goyal, Abhinav; Norton, Catherine R.; Thomas, Tracy N.; Davis, Robert; Butler, Javed; Ashok, Varun; Zhao, Liping; Vaccarino, Viola; Wilson, Peter W.F.

In: Circulation: Heart Failure, Vol. 3, No. 6, 01.11.2010, p. 698-705.

Research output: Contribution to journalArticle

Goyal, A, Norton, CR, Thomas, TN, Davis, R, Butler, J, Ashok, V, Zhao, L, Vaccarino, V & Wilson, PWF 2010, 'Predictors of incident heart failure in a large insured population: A one million person-year follow-up study', Circulation: Heart Failure, vol. 3, no. 6, pp. 698-705. https://doi.org/10.1161/CIRCHEARTFAILURE.110.938175
Goyal, Abhinav ; Norton, Catherine R. ; Thomas, Tracy N. ; Davis, Robert ; Butler, Javed ; Ashok, Varun ; Zhao, Liping ; Vaccarino, Viola ; Wilson, Peter W.F. / Predictors of incident heart failure in a large insured population : A one million person-year follow-up study. In: Circulation: Heart Failure. 2010 ; Vol. 3, No. 6. pp. 698-705.
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AB - Background - Studies on the incidence and predictors of heart failure (HF) are often restricted to elderly persons or identify only inpatient cases. Methods and Results - We determined the incidence and predictors of new HF diagnosed in either outpatient or inpatient settings, among 359 947 women and men (age ≥18 years) insured by Kaiser Permanente Georgia at any time during calendar years 2000 to 2005. Subjects were free of HF at baseline, and incident HF was identified with ICD-9 codes (1 inpatient or 2 outpatient HF visits). We developed multivariable Cox models to assess the association of antecedent factors (coronary heart disease, hypertension, diabetes mellitus, atrial fibrillation, and valvular heart disease) with incident HF. Separate models were created for each sex and for newly diagnosed HF in outpatient or inpatient settings. There were 4001 incident HF cases (50% women and 48% in subjects <65 years old), during 1 015 794 person-years of follow-up. The incidence rate of HF was greater in men than in women (4.24 versus 3.68 per 1000 person-years) but was stable across the study interval in both sexes. Two thirds of incident HF cases from this population occurred in outpatients. These 5 antecedent factors and age yielded excellent discrimination for incident HF in both outpatients and inpatients and in both sexes (C >0.85 in all models). Conclusions - Common modifiable risk factors accurately discriminate women and men at risk for HF diagnosed in either outpatient or inpatient settings. Approximately two thirds of new HF cases in our insured population were diagnosed in outpatients; more research is needed to characterize these subjects and their prognosis. (Circ Heart Fail. 2010;3:698-705.).

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