Incident heart failure in relation to vascular disease: insights from the Health, Aging, and Body Composition Study

Abstract

Aims: The contribution of heart failure (HF) unrelated to vascular disease to the overall HF burden in older adults is not well characterized. This was investigated in this study.

Methods and results: We assessed HF incidence and outcomes in 2895 participants of the Health ABC Study (age 74 ± 3 years, 48.4% men, 41.4% black) in relation to vascular disease (coronary, peripheral, or cerebrovascular disease) either present at baseline or developed prior to HF. During 11.4 years follow-up, 493 participants developed HF; 134 (27.2%) in participants without any prior vascular disease and 177 (36.8%) without coronary disease. Both baseline [hazard ratio (HR) 2.4, 95% confidence interval (CI) 1.9-2.8] and incident vascular disease (HR 4.3, 95% CI 3.6-5.2) were associated with HF. During a median follow-up of 2.1 years after HF onset, 67.5% participants died. Annual mortality after HF development was 21.3% in those with compared with 24.6% in those without vascular disease (HR 1.11, 95% CI 0.87-1.43; P = 0.399). There were 658 all-cause (436.3/1000 person-years) and 523 HF-related (346.4/1000 person-years) hospitalizations after HF development. There was no significant difference in hospitalizations between those with and without vascular disease [rate ratio (RR) 1.04, 95% CI 0.86-1.24 for all-cause, and RR 0.84 95% CI 0.69-1.02 for HF hospitalization]. HF with preserved EF was more common in participants without vascular disease (67.0% vs. 55.0%, P = 0.040).

Conclusion: A significant proportion of HF in older adults develops without prior vascular disease. Outcomes for these patients are poor compared with those with preceding vascular disease. These data suggest the need for more targeted HF prediction and prevention efforts.

Keywords: Epidemiology; Heart failure; Race; Sex.

Figure 1

Incident heart failure events stratified by vascular disease

Figure 2. Heart failure rates per 1000 person-years

Error bars represent 95% confidence intervals.

Figure 3. Incident heart failure by race, gender, and vascular disease status

Individuals with vascular disease were more likely to develop HF (stratified log-rank χ² for vascular disease 165.69, P<0.0001). Blacks participants with prior vascular disease were more likely to develop HF (stratified log-rank χ² for sex 0.41, P=0.523; for race 4.21, P=.04) but not in those without vascular disease (stratified log-rank χ² for sex 0.23, P=.63; for race 2.48, P=.11).

Figure 4. Cumulative survival by HF status, vascular disease status and history of LVH

A: LVH status at baseline did not affect overall survival (stratified log-rank χ² for LVH 0.05, P=0.828) B: Individuals with HF overall had shorter survival than those without HF (stratified log-rank χ² for vascular disease 108.13, P<0.0001). C Individuals with prior vascular disease had shorter survival than those without prior vascular disease (stratified log-rank χ² for prior vascular disease 40.67, P=<0.001). D In individuals with HF both with and without prior vascular disease had a lower cumulative survival than those with no HF and prior vascular disease or those without HF and vascular disease (stratified log-rank χ² 152.18, P=<0.001).