Predicting Heart Failure with Preserved and Reduced Ejection Fraction

The International Collaboration on Heart Failure Inftypes

Jennifer E. Ho, Danielle Enserro, Frank P. Brouwers, Jorge R. Kizer, Sanjiv J. Shah, Bruce M. Psaty, Traci M. Bartz, Rajalakshmi Santhanakrishnan, Douglas S. Lee, Cheeling Chan, Kiang Liu, Michael Blaha, Hans L. Hillege, Pim Van Der Harst, Wiek H. Van Gilst, Willem J. Kop, Ron T. Gansevoort, Ramachandran S. Vasan, Julius M. Gardin, Daniel Levy & 3 others John S. Gottdiener, Rudolf A. De Boer, Martin G. Larson

Research output: Contribution to journalArticle

Abstract

Background-Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF inftypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). Methods and Results-Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF inftype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95% CI, 0.77-0.82 and external: 0.76; 95% CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80-0.84) and validation samples (internal: 0.80; 95% CI, 0.78-0.83 and external: 0.76; 95% CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). Conclusions-We describe and validate risk prediction models for HF inftypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF inftypes.

Original languageEnglish (US)
Article numbere003116
JournalCirculation: Heart Failure
Volume9
Issue number6
DOIs
StatePublished - Jun 1 2016

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Heart Failure
Confidence Intervals
Bundle-Branch Block
Left Ventricular Hypertrophy
Smoking
Myocardial Infarction
Blood Pressure
Antihypertensive Agents
Diabetes Mellitus
Body Mass Index

Keywords

  • diastolic heart failure
  • phenotype
  • primary prevention
  • risk factor
  • systolic heart failure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Predicting Heart Failure with Preserved and Reduced Ejection Fraction : The International Collaboration on Heart Failure Inftypes. / Ho, Jennifer E.; Enserro, Danielle; Brouwers, Frank P.; Kizer, Jorge R.; Shah, Sanjiv J.; Psaty, Bruce M.; Bartz, Traci M.; Santhanakrishnan, Rajalakshmi; Lee, Douglas S.; Chan, Cheeling; Liu, Kiang; Blaha, Michael; Hillege, Hans L.; Van Der Harst, Pim; Van Gilst, Wiek H.; Kop, Willem J.; Gansevoort, Ron T.; Vasan, Ramachandran S.; Gardin, Julius M.; Levy, Daniel; Gottdiener, John S.; De Boer, Rudolf A.; Larson, Martin G.

In: Circulation: Heart Failure, Vol. 9, No. 6, e003116, 01.06.2016.

Research output: Contribution to journalArticle

Ho, JE, Enserro, D, Brouwers, FP, Kizer, JR, Shah, SJ, Psaty, BM, Bartz, TM, Santhanakrishnan, R, Lee, DS, Chan, C, Liu, K, Blaha, M, Hillege, HL, Van Der Harst, P, Van Gilst, WH, Kop, WJ, Gansevoort, RT, Vasan, RS, Gardin, JM, Levy, D, Gottdiener, JS, De Boer, RA & Larson, MG 2016, 'Predicting Heart Failure with Preserved and Reduced Ejection Fraction: The International Collaboration on Heart Failure Inftypes', Circulation: Heart Failure, vol. 9, no. 6, e003116. https://doi.org/10.1161/CIRCHEARTFAILURE.115.003116
Ho, Jennifer E. ; Enserro, Danielle ; Brouwers, Frank P. ; Kizer, Jorge R. ; Shah, Sanjiv J. ; Psaty, Bruce M. ; Bartz, Traci M. ; Santhanakrishnan, Rajalakshmi ; Lee, Douglas S. ; Chan, Cheeling ; Liu, Kiang ; Blaha, Michael ; Hillege, Hans L. ; Van Der Harst, Pim ; Van Gilst, Wiek H. ; Kop, Willem J. ; Gansevoort, Ron T. ; Vasan, Ramachandran S. ; Gardin, Julius M. ; Levy, Daniel ; Gottdiener, John S. ; De Boer, Rudolf A. ; Larson, Martin G. / Predicting Heart Failure with Preserved and Reduced Ejection Fraction : The International Collaboration on Heart Failure Inftypes. In: Circulation: Heart Failure. 2016 ; Vol. 9, No. 6.
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abstract = "Background-Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF inftypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). Methods and Results-Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF inftype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95{\%} confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95{\%} CI, 0.77-0.82 and external: 0.76; 95{\%} CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95{\%} CI, 0.80-0.84) and validation samples (internal: 0.80; 95{\%} CI, 0.78-0.83 and external: 0.76; 95{\%} CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). Conclusions-We describe and validate risk prediction models for HF inftypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF inftypes.",
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author = "Ho, {Jennifer E.} and Danielle Enserro and Brouwers, {Frank P.} and Kizer, {Jorge R.} and Shah, {Sanjiv J.} and Psaty, {Bruce M.} and Bartz, {Traci M.} and Rajalakshmi Santhanakrishnan and Lee, {Douglas S.} and Cheeling Chan and Kiang Liu and Michael Blaha and Hillege, {Hans L.} and {Van Der Harst}, Pim and {Van Gilst}, {Wiek H.} and Kop, {Willem J.} and Gansevoort, {Ron T.} and Vasan, {Ramachandran S.} and Gardin, {Julius M.} and Daniel Levy and Gottdiener, {John S.} and {De Boer}, {Rudolf A.} and Larson, {Martin G.}",
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T1 - Predicting Heart Failure with Preserved and Reduced Ejection Fraction

T2 - The International Collaboration on Heart Failure Inftypes

AU - Ho, Jennifer E.

AU - Enserro, Danielle

AU - Brouwers, Frank P.

AU - Kizer, Jorge R.

AU - Shah, Sanjiv J.

AU - Psaty, Bruce M.

AU - Bartz, Traci M.

AU - Santhanakrishnan, Rajalakshmi

AU - Lee, Douglas S.

AU - Chan, Cheeling

AU - Liu, Kiang

AU - Blaha, Michael

AU - Hillege, Hans L.

AU - Van Der Harst, Pim

AU - Van Gilst, Wiek H.

AU - Kop, Willem J.

AU - Gansevoort, Ron T.

AU - Vasan, Ramachandran S.

AU - Gardin, Julius M.

AU - Levy, Daniel

AU - Gottdiener, John S.

AU - De Boer, Rudolf A.

AU - Larson, Martin G.

PY - 2016/6/1

Y1 - 2016/6/1

N2 - Background-Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF inftypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). Methods and Results-Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF inftype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95% CI, 0.77-0.82 and external: 0.76; 95% CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80-0.84) and validation samples (internal: 0.80; 95% CI, 0.78-0.83 and external: 0.76; 95% CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). Conclusions-We describe and validate risk prediction models for HF inftypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF inftypes.

AB - Background-Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF inftypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF). Methods and Results-Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF inftype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78-0.82) and validation samples (internal: 0.79; 95% CI, 0.77-0.82 and external: 0.76; 95% CI: 0.71-0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80-0.84) and validation samples (internal: 0.80; 95% CI, 0.78-0.83 and external: 0.76; 95% CI, 0.71-0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02). Conclusions-We describe and validate risk prediction models for HF inftypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF inftypes.

KW - diastolic heart failure

KW - phenotype

KW - primary prevention

KW - risk factor

KW - systolic heart failure

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