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First evaluation using a validated scale of the risk of congestive heart failure among hypertensive patients treated
Albert Alain Hagège1, Nacima Demil, Gilles Errieau
1hôpital européen Georges-Pompidou, Assistance publique-Hôpitaux de Paris, université Paris Descartes, 75015 Paris, France. albert.hagege@egp.aphp.fr
Insights
Hypertension management often overlooks heart failure (HF) risk. A study found over 10% of hypertensive patients face high HF risk, highlighting the need for better risk assessment tools in primary care.
Area of Science:
- Cardiology
- Primary Care Medicine
- Public Health
Background:
- Hypertension is a major risk factor for heart failure (HF), yet HF risk assessment in hypertensive adults is under-researched.
- Current management primarily focuses on coronary artery disease risk factors, neglecting HF-specific risks.
Purpose of the Study:
- To evaluate heart failure (HF) risk components in hypertensive patients within primary care settings.
- To compare physicians' subjective risk estimations against established algorithms for HF and global cardiovascular risk.
- To assess the agreement between different risk calculation algorithms.
Main Methods:
- The O-PREDICT study surveyed 1537 French general practitioners who assessed 4523 hypertensive, non-HF patients.
- Patients were categorized by age (<60, 60-70, >70 years).
- Heart failure (HF) risk (4-year) and global cardiovascular risk (10-year) were estimated by physicians and calculated using Framingham and SCORE algorithms, respectively, with risk stratification into four categories.
Main Results:
- The study included 4523 hypertensive patients (61% male, mean age 64.5 years).
- Common risk factors included dyslipidemia (48.8%), left ventricular hypertrophy (25.3%), and diabetes (18.8%).
- The Framingham algorithm identified 13.4% of patients at high risk for HF. Physician risk estimations showed poor concordance with both Framingham and SCORE algorithms (kappa values < 0.3).
Conclusions:
- Over 10% of hypertensive patients in primary care are at high risk for heart failure (HF) within 4 years, per the Framingham model.
- The Framingham algorithm provides additional risk information beyond the SCORE system for hypertensive patients.
- Physician risk assessments poorly correlated with algorithmic calculations, indicating a need to promote the use of risk assessment tools in general practice.
Background:
Routine management of hypertensive adults is based on assessment of risk factors for coronary artery disease; risk factors for heart failure (HF) remain poorly investigated despite the key role of hypertension in HF development.
Aim:
To assess the components of HF risk in hypertensive adults in primary care, compare physicians' estimations of HF and global cardiovascular risks with established calculation algorithms, and assess the concordance of these algorithms.
Methods:
O-PREDICT was a transverse, observational, multicentre French survey conducted in 2006 among general practitioners who included the first hypertensive, non-HF patient seen in each of three age classes (<60, 60-70, >70 years). Estimations of HF and global cardiovascular risks (at 4 and 10 years, respectively) were performed subjectively during the consultation and calculated a posteriori according to algorithms from the Framingham cohort and the European SCORE database, respectively. For each of these methods, patients were stratified into four risk categories (i.e., no, low, moderate, high).
Results:
One thousand five hundred and thirty seven physicians recruited 4523 patients (61% men; 64.5+/-10.9 years; systolic blood pressure 149.9+/-15.4 mmHg); most (67.2%) patients had one or two cardiovascular/HF risk factors (dyslipidaemia 48.8%, left ventricular hypertrophy 25.3%, diabetes 18.8%, coronary artery disease 8.8%, valvulopathy 6.1%); the number increased with advancing age and in men versus women. According to the Framingham algorithm, the risk of HF (mean 5.4+/-8.5%; 13.4% of patients at high risk) increased with advancing age (p<0.001), nearly doubling for each decade increase. According to the European SCORE system, global cardiovascular risk (mean 5.4+/-4.3%) was moderate or elevated in 48.1% of patients. Concordance between physicians' estimations and theoretical calculations for HF and global risks was poor, as was concordance between algorithms (kappa(w)=0.28, 0.12, 0.11, respectively).
Conclusion:
More than one in 10 hypertensive patients seen in primary care is at high risk of HF at 4 years according to the Framingham model; this algorithm appears to offer additional information to that provided by the SCORE system. Physicians' estimations of risks correlated poorly with algorithm calculations, suggesting that the use of these tools in general practice should be encouraged.
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