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Predictors of congestive heart failure in the elderly: the Cardiovascular Health Study
J S Gottdiener1, A M Arnold, G P Aurigemma
1Division of Cardiology, Georgetown University Hospital, Washington, DC, USA. gottdien@ziplink.net
Insights
Congestive heart failure (CHF) incidence rises with age and is higher in men, influenced by heart disease, high blood pressure, and inflammation. While LV dysfunction and atrial fibrillation pose risks, their population impact is limited by lower prevalence in older adults.
Area of Science:
- Cardiology
- Geriatrics
- Epidemiology
Background:
- Congestive heart failure (CHF) is a significant cause of morbidity and mortality in the elderly.
- Elderly patients with CHF exhibit distinct biological characteristics compared to younger populations.
Purpose of the Study:
- To identify predictors of new-onset congestive heart failure (CHF) in an elderly, community-dwelling population.
- To characterize the factors contributing to CHF development in individuals over 65 years old.
Main Methods:
- Analysis of data from the Cardiovascular Health Study, a prospective study of 5,888 elderly individuals (>65 years).
- Inclusion of laboratory measures, blood chemistries, and functional assessments.
- Central adjudication of incident congestive heart failure (CHF) cases.
Main Results:
- The incidence of CHF was 19.3 per 1,000 person-years, increasing with age and higher in men.
- Independent predictors included coronary heart disease, stroke, diabetes, systolic blood pressure, inflammation (C-reactive protein), and atrial fibrillation.
- High population-attributable risk was observed for coronary heart disease, elevated systolic blood pressure, and high C-reactive protein levels.
Conclusions:
- CHF incidence in the elderly is primarily linked to age, gender, coronary heart disease, systolic blood pressure, and inflammation.
- While left ventricular (LV) systolic dysfunction and atrial fibrillation carry high relative risks, their overall population impact on CHF is limited by lower prevalence.
Objectives:
We sought to characterize the predictors of incident congestive heart failure (CHF), as determined by central adjudication, in a community-based elderly population.
Background:
The elderly constitute a growing proportion of patients admitted to the hospital with CHF, and CHF is a leading source of morbidity and mortality in this group. Elderly patients differ from younger individuals diagnosed with CHF in terms of biologic characteristics.
Methods:
We analyzed data from the Cardiovascular Health Study, a prospective population-based study of 5,888 elderly people >65 years old (average 73 +/- 5, range 65 to 100) at four locations. Multiple laboratory measures of cardiovascular structure and function, blood chemistries and functional assessments were obtained.
Results:
During an average follow-up of 5.5 years (median 6.3), 597 participants developed incident CHF (rate 19.3/1,000 person-years). The incidence of CHF increased progressively across age groups and was greater in men than in women. On multivariate analysis, other independent predictors included prevalent coronary heart disease, stroke or transient ischemic attack at baseline, diabetes, systolic blood pressure (BP), forced expiratory volume 1 s, creatinine >1.4 mg/dl, C-reactive protein, ankle-arm index <0.9, atrial fibrillation, electrocardiographic (ECG) left ventricular (LV) mass, ECG ST-T segment abnormality, internal carotid artery wall thickness and decreased LV systolic function. Population-attributable risk, determined from predictors of risk and prevalence, was relatively high for prevalent coronary heart disease (13.1%), systolic BP > or =140 mm Hg (12.8%) and a high level of C-reactive protein (9.7%), but was low for subnormal LV function (4.1%) and atrial fibrillation (2.2%).
Conclusions:
The incidence of CHF is high in the elderly and is related mainly to age, gender, clinical and subclinical coronary heart disease, systolic BP and inflammation. Despite the high relative risk of subnormal systolic LV function and atrial fibrillation, the actual population risk of these for CHF is small because of their relatively low prevalence in community-dwelling elderly people.