Risk factors for incident heart failure in age- and sex-specific strata: a population-based cohort using linked electronic health records

Abstract

Aims: Several risk factors for incident heart failure (HF) have been previously identified, however large electronic health records (EHR) datasets may provide the opportunity to examine the consistency of risk factors across different subgroups from the general population.

Methods and results: We used linked EHR data from 2000 to 2010 as part of the UK-based CALIBER resource to select a cohort of 871 687 individuals 55 years or older and free of HF at baseline. The primary endpoint was the first record of HF from primary or secondary care. Cox proportional hazards analysis was used to estimate hazard ratios for associations between risk factors and incident HF, separately for men and women and by age category: 55-64, 65-74, and > 75 years. During 5.8 years of median follow-up, a total of 47 987 incident HF cases were recorded. Age, social deprivation, smoking, sedentary lifestyle, diabetes, atrial fibrillation, chronic obstructive pulmonary disease, body mass index, haemoglobin, total white blood cell count and creatinine were associated with HF. Smoking, atrial fibrillation and diabetes showed stronger associations with incident HF in women compared to men.

Conclusion: We confirmed associations of several risk factors with HF in this large population-based cohort across age and sex subgroups. Mainly modifiable risk factors and comorbidities are strongly associated with incident HF, highlighting the importance of preventive strategies targeting such risk factors for HF.

Keywords: Electronic health records; Heart failure; Incidence; Population attributable risk; Risk factors.

Figure 1

Incidence rate (per 1000 person‐years) of heart failure in England between 2000 and 2009 stratified by age category and sex. Incidence rate/1000 person‐years with 95% confidence interval (band), table with absolute number of cases stratified by age category and sex.

Figure 2

Forest plot of multivariable hazard ratios [95% confidence interval (CI)] of risk factors for incident heart failure, stratified by age and sex. Results of the multivariable model showing independent hazard ratios of other variables shown and further adjusted for ethnicity, blood pressure‐lowering medication and lipid‐regulating drugs and stratified by age and sex. Square boxes = 55–64 years, circle boxes = 65–74 years and diamond boxes = > 75 years. *Hazard ratios were considered statistically significant if P < 0.001 (Bonferroni corrected threshold). Patient (events) men: age category 55–64 years n (events) = 257 698 (5408), age category 65–74 years n (events) = 88 416 (8047), age category >75 years n (events) = 58 531 (9859). Patient (events) women: age category 55–64 years n (events) = 257 364 (2878), age category 65–74 years n (events) = 101 192 (6624), age category >75 years n (events) = 108 486 (15171). BMI, body mass index; COPD, chronic obstructive pulmonary disease.