Despite the increasing elderly population and rising heart failure (HF) burden, epidemiology of incident HF in the elderly is not well described. We studied 2934 elderly participants without prevalent HF enrolled in the Health ABC study (aged 73.6 ± 2.9 years, 47.9% men, 58.6% white, 41.6% black) and assessed incidence rates, population attributable risk (PAR) for independent risk factors, and outcomes of incident HF. After 7.1 year median follow-up, 258 (8.8%) participants developed HF requiring hospitalization (annual rate: 13.6 per 1000 participants). Men and blacks were more likely to develop HF than women and whites: annual rate was 16.3/1000 in blacks vs. 11.9/1000 in whites [hazard ratio (HR) 1.41, 95% confidence interval (CI), 1.11–1.80, p = 0.006]; and 15.8/1000 in men vs. 11.7/1000 in women (HR 1.34, 95% CI, 1.05–1.71, p = 0.021). Coronary heart disease and uncontrolled blood pressure had the highest PAR ( > 20% each) both in whites and blacks (Table 1
); a substantial proportion of incident HF was attributable to metabolic and cardio-renal risk factors. The fraction of incident HF cases attributable to modifiable risk factors was higher in blacks vs. whites (68% vs. 49%). No significant sex-based differences were observed in risk factors and PAR. Participants who developed HF had a considerably higher annual mortality than HF-free participants (18.0% vs. 2.7%). Survival after HF did not differ between whites and blacks; however, rehospitalization rates were two-fold higher in blacks compared to whites (62.1 vs. 30.3 per 100 patient-years, p < 0.001), due to a higher rate of HF related readmissions in blacks. Incident HF is common in the elderly and is associated with poor outcomes. A large proportion of incident HF risk was attributed to modifiable risk factors. Significant racial differences in PAR for risk factors and hospitalization rates after incident HF need to be accounted for future prevention and treatment efforts.
Table 1.
Adjusted rate ratios and population attributable risk for the modifiable risk factors of incident heart failure in the Health ABC study
Racial Differences in Incident Heart Failure among Young Adults
