10-Year Risk Equations for Incident Heart Failure in the General Population

Abstract

Background: Primary prevention strategies to mitigate the burden of heart failure (HF) are urgently needed. However, no validated risk prediction tools are currently in use.

Objectives: This study sought to derive 10-year risk equations of developing incident HF.

Methods: Race- and sex-specific 10-year risk equations for HF were derived and validated from individual-level data from 7 community-based cohorts with at least 12 years of follow-up. Participants who were recruited between 1985 and 2000, between 30 to 79 years, and were free of cardiovascular disease at baseline were included to create a pooled cohort (PC) and were randomly split for derivation and internal validation. Model performance was also assessed in 2 additional cohorts.

Results: In the derivation sample of the PC (n = 11,771), 58% were women, 22% were black with a mean age of 52 ± 12 years, and HF occurred in 1,339 participants. Predictors of HF included in the race-sex-specific models were age, blood pressure (treated or untreated), fasting glucose (treated or untreated), body mass index, cholesterol, smoking status, and QRS duration. The PC equations to Prevent HF model had good discrimination and strong calibration in internal and external validation cohorts. A web-based tool was developed to facilitate clinical application of this tool.

Conclusions: The authors present a contemporary analysis from 33,010 men and women demonstrating the utility of the sex- and race-specific 10-year PC equations to Prevent HF risk score, which integrates clinical parameters readily available in primary care settings. This tool can be useful in risk-based decision making to determine who may merit intensive screening and/or targeted prevention strategies.

Keywords: epidemiology; heart failure; primary prevention; risk factor.

Central Illustration:. Examples of predicted 10-year heart failure risk using the online PCP-HF tool in a 50-year-old black man and 65-year old white woman.

Ten-year predicted HF risk is high and similar for a 50-year black man and a 65-year old white woman with the following risk profile: treated systolic blood pressure 140 mm Hg, body mass index 35 kg/m², untreated fasting glucose 120mg/dL, total cholesterol 200mg/dL, HDL-C 45 mg/dL, current smoker, and QRS of 90ms.

Figure 1.. Sex- and Race-Specific Calibration Plots in the Validation Sample of the Pooled Cohort (n=11,770) with Discrimination and Calibration Statistics.

Calibration of the Pooled Cohort equations to Prevent Heart Failure (PCP-HF) risk score in the randomly split validation sample of the pooled cohort, which includes the ARIC, CARDIA, CHS, FOF, and MESA cohorts. Participants are grouped into deciles (collapsed when fewer than 2 events were observed in any group) according to increasing predicted risk and average predicted risk is compared with average observed risk in each category in each sex-race group. The model demonstrated good to excellent discrimination with c-statistics ranging from 0.71-0.85 and strong calibration (chi-sq p>0.05 for all sex-race groups).

Figure 2.. Calibration Plots in the Jackson Heart Study and PREVEND Validation Samples with Discrimination and Calibration Statistics.

Calibration of the Pooled Cohort equations to Prevent Heart Failure (PCP-HF) risk score in 2 large population-based cohorts of White (PREVEND) and Black (Jackson Heart Study) adults aged 30-80 years after excluding individuals with prevalent CVD. The remaining participants were grouped into deciles (collapsed when fewer than 2 events were observed in any group) according to increasing predicted risk and average predicted risk is compared with average observed risk in each sex-race group. The model demonstrated good discrimination with c-statistics ranging from 0.74-0.79 and strong calibration (chi-sq <20 with p>0.05 for all sex-race groups except white men p=0.03).

Figure 3.. Sex- and Race-Specific 10-year Heart Failure Risk Estimates for a 50-year-old White and Black Man and Woman based on Optimal, Intermediate, and High Risk Profiles.

Heart failure risk estimated by the Pooled Cohort equations to Prevent Heart Failure varies significantly based on risk factor profile among race-sex groups. For an optimal RF profile (never smoker, systolic blood pressure of 120mm Hg, fasting glucose of 90mg/dL, no treatment for hypertension or diabetes, BMI of 22kg/m², total cholesterol of 180 mg/dL, HDL cholesterol of 55 mg/dL, and QRS duration of 90ms), 10-year risk is greatest among black men (0.8%) and lowest among white women (0.3%). Among participants with a high risk profile (current smoker, systolic blood pressure of 150mm Hg, fasting glucose of 126 mg/dL, treatment for hypertension and diabetes, BMI of 35 kg/m², total cholesterol of 250 mg/dL, HDL cholesterol of 30 mg/dL, and QRS duration of 120ms), 10-year predicted risk varies greatly ranging from lowest risk among white women (14%) to highest risk among black men (24%) and women (26%).