Incident heart failure prediction in the elderly: the health ABC heart failure score

Abstract

Background: Despite the rising heart failure (HF) incidence and aging United States population, there are no validated prediction models for incident HF in the elderly. We sought to develop a new prediction model for 5-year risk of incident HF among older persons.

Methods and results: Proportional hazards models were used to assess independent predictors of incident HF, defined as hospitalization for new-onset HF, in 2935 elderly participants without baseline HF enrolled in the Health ABC study (age, 73.6 +/- 2.9 years, 47.9% males, 58.6% whites). A prediction equation was developed and internally validated by bootstrapping, allowing the development of a 5-year risk score. Incident HF developed in 258 (8.8%) participants during 6.5 +/- 1.8 years of follow-up. Independent predictors of incident HF included age, history of coronary disease and smoking, baseline systolic blood pressure and heart rate, serum glucose, creatinine, and albumin levels, and left ventricular hypertrophy. The Health ABC HF model had a c-statistic of 0.73 in the derivation dataset, 0.72 by internal validation (optimism-corrected), and good calibration (goodness-of-fit 2 6.24, P=0.621). A simple point score was created to predict incident HF risk into 4 risk groups corresponding to <5%, 5% to 10%, 10% to 20%, and >20% 5-year risk. The actual 5-year incident HF rates in these groups were 2.9%, 5.7%, 13.3%, and 36.8%, respectively.

Conclusion: The Health ABC HF prediction model uses common clinical variables to predict incident HF risk in the elderly, an approach that may be used to target and treat high-risk individuals.

Keywords: elderly; epidemiology; heart failure; risk factors; statistical models.

Figure 1. Calibration of the Health ABC Heart Failure Model

Actual vs. predicted development of incident heart failure (HF) based on deciles of risk is shown. The corresponding Hosmer-Lemeshow χ² was 6.24, p=0.621, indicating that the model was well-calibrated.

Figure 2

The Health ABC Heart Failure Score.

Figure 3. Incident Heart Failure in the Health ABC HF Score-based risk groups

Kaplan-Meier curves for incident heart failure development based on the four Health ABC risk groups.

Figure 4. Predictions across gender and race

The Health ABC Heart Failure Score performed well in both genders and among white and black participants in the Health ABC study.