PCV28 CHARACTERIZATION OF COSTS AND PATIENTS WITH INCIDENT HEART FAILURE (HF) INCURRING THE HIGHEST HEALTHCARE COSTS FROM SECONDARY CARE: A RETROSPECTIVE, POPULATION-BASED COHORT STUDY IN SWEDEN

AbstractImportanceHeart failure constitutes a high burden on patients and society, but although lifetime risk is high, it is difficult to predict without costly or invasive testing. Knowledge about novel risk factors could enable early diagnosis and possibly preemptive treatment.ObjectiveTo establish new risk factors for heart failure.DesignWe applied supervised machine learning in UK Biobank in an agnostic search of risk factors for heart failure. Novel predictors were then subjected to several in-depth analyses, including multivariable Cox models of incident heart failure, and assessment of discrimination and calibration.SettingPopulation-based cohort study.Participants500,451 individuals who volunteered to participate in the UK Biobank cohort study, excluding those with prevalent heart failure.Exposure3646 variables reflecting different aspects of lifestyle, health and disease-related factors.Main OutcomeIncident heart failure hospitalization.ResultsMachine learning confirmed many known and putative risk factors for heart failure, and identified several novel candidates. Mean reticulocyte volume appeared as one novel factor, and leg bioimpedance another; the latter appearing as the most important new factor. Leg bioimpedance was significantly lower in those who developed heart failure (p=1.1x10-72) during up to 9.8-year follow-up. When adjusting for known heart failure risk factors, leg bioimpedance was inversely related to heart failure (hazard ratio [95%CI], 0.60 [0.48–0.73]) and 0.75 [0.59–0.94], in age- and sex-adjusted and fully adjusted models, respectively, comparing the upper vs. lower quartile). A model including leg bioimpedance, age, sex, and self-reported history of myocardial infarction showed good predictive capacity of future heart failure hospitalization (C-index=0.82) and good calibration.Conclusions and RelevanceLeg bioimpedance is inversely associated with heart failure incidence in the general population. A simple model of exclusively non-invasive measures, combining leg bioimpedance with history of myocardial infarction, age, and sex provides accurate predictive capacity.Key pointsQuestionWhich are the most important risk factors for incident heart failure?FindingsIn this population-based cohort study of ~500,000 individuals, machine learning identified well-established risk factors, but also several novel factors. Among the most important were leg bioimpedance and mean reticulocyte volume. There was a strong inverse relationship between leg bioimpedance and incident heart failure, also in adjusted analyses. A model entailing leg bioimpedance, age, sex, and self-reported history of myocardial infarction showed good predictive capacity of heart failure hospitalization and good calibration.MeaningLeg bioimpedance appears to be an important new factor associated with incident heart failure.

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NON-APNOEA SLEEP DISORDER INCREASES THE RISK OF INCIDENT HEART FAILURE-A NATIONWIDE POPULATION-BASED COHORT STUDY

Respirology ◽

10.1111/resp.13419_87 ◽

2018 ◽

Vol 23 ◽

pp. 38-39

Keyword(s):

Heart Failure ◽

Cohort Study ◽

Sleep Disorder ◽

Population Based ◽

Incident Heart Failure

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Prediabetes is not an independent risk factor for incident heart failure, other cardiovascular events or mortality in older adults: Findings from a population-based cohort study

International Journal of Cardiology ◽

10.1016/j.ijcard.2013.05.038 ◽

2013 ◽

Vol 168 (4) ◽

pp. 3616-3622 ◽

Cited By ~ 21

Author(s):

Prakash Deedwania ◽

Kanan Patel ◽

Gregg C. Fonarow ◽

Ravi V. Desai ◽

Yan Zhang ◽

...

Keyword(s):

Heart Failure ◽

Older Adults ◽

Risk Factor ◽

Cohort Study ◽

Cardiovascular Events ◽

Independent Risk Factor ◽

Population Based ◽

Incident Heart Failure

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Age dependent associations of risk factors with heart failure: pooled population based cohort study

BMJ ◽

10.1136/bmj.n461 ◽

2021 ◽

pp. n461

Author(s):

Jasper Tromp ◽

Samantha M A Paniagua ◽

Emily S Lau ◽

Norrina B Allen ◽

Michael J Blaha ◽

...

Keyword(s):

Risk Factors ◽

Heart Failure ◽

Cohort Study ◽

Absolute Risk ◽

Population Based ◽

Attributable Risk ◽

Smoking History ◽

Middle Aged ◽

Current Smoking ◽

Incident Heart Failure

Abstract Objective To assess age differences in risk factors for incident heart failure in the general population. Design Pooled population based cohort study. Setting Framingham Heart Study, Prevention of Renal and Vascular End-stage Disease Study, and Multi-Ethnic Study of Atherosclerosis. Participants 24 675 participants without a history of heart failure stratified by age into young (<55 years; n=11 599), middle aged (55-64 years; n=5587), old (65-74 years; n=5190), and elderly (≥75 years; n=2299) individuals. Main outcome measure Incident heart failure. Results Over a median follow-up of 12.7 years, 138/11 599 (1%), 293/5587 (5%), 538/5190 (10%), and 412/2299 (18%) of young, middle aged, old, and elderly participants, respectively, developed heart failure. In young participants, 32% (n=44) of heart failure cases were classified as heart failure with preserved ejection fraction compared with 43% (n=179) in elderly participants. Risk factors including hypertension, diabetes, current smoking history, and previous myocardial infarction conferred greater relative risk in younger compared with older participants (P for interaction <0.05 for all). For example, hypertension was associated with a threefold increase in risk of future heart failure in young participants (hazard ratio 3.02, 95% confidence interval 2.10 to 4.34; P<0.001) compared with a 1.4-fold risk in elderly participants (1.43, 1.13 to 1.81; P=0.003). The absolute risk for developing heart failure was lower in younger than in older participants with and without risk factors. Importantly, known risk factors explained a greater proportion of overall population attributable risk for heart failure in young participants (75% v 53% in elderly participants), with better model performance (C index 0.79 v 0.64). Similarly, the population attributable risks of obesity (21% v 13%), hypertension (35% v 23%), diabetes (14% v 7%), and current smoking (32% v 1%) were higher in young compared with elderly participants. Conclusions Despite a lower incidence and absolute risk of heart failure among younger compared with older people, the stronger association and greater attributable risk of modifiable risk factors among young participants highlight the importance of preventive efforts across the adult life course.

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