Heart failure risk prediction in the Multi-Ethnic Study of Atherosclerosis

Abstract

Objective Heart failure (HF) is a leading cause of mortality especially in older populations. Early detection of high-risk individuals is imperative for primary prevention. The purpose of this study was to develop a HF risk model from a population without clinical cardiac disease. Methods The Multi-Ethnic Study of Atherosclerosis is a multicentre observational cohort study following 6814 subjects (mean age 62±10 years; 47% men) who were free of clinical cardiovascular disease at baseline. Median follow-up was 4.7 years. HF events developed in 176 participants. Cox proportional hazards models and regression coefficients were used to determine independent risk factors and generate a 5-year risk score for incident HF. Bootstrapping with bias correction was used for internal validation. Results Independent predictors for HF (HR, p value) were age (1.30 (1.10 to 1.50) per 10 years), male gender (2.27 (1.53 to 3.36)), current smoking (1.97 (1.15 to 3.36)), body mass index (1.40 (1.10 to 1.80) per 5 kg/m2), systolic blood pressure (1.10 (1.00 to 1.10) per 10 mm Hg), heart rate (1.30) (1.10 to 1.40) per 10 bpm), diabetes (2.27 (1.48 to 3.47)), N-terminal pro-B-type natriuretic peptide (NT proBNP) (2.48 (2.16 to 2.84) per unit log increment) and left ventricular mass index (1.40 (1.30 to 1.40) per 10 g/m2). A parsimonious model based on age, gender, body mass index, smoking status, systolic blood pressure, heart rate, diabetes and NT proBNP natriuretic peptide predicted incident HF risk with a c-statistic of 0.87. Conclusions A clinical algorithm based on risk factors readily available in the primary care setting can used to identify individuals with high likelihood of developing HF without pre-existing cardiac disease.

Cardiovascular Event Prediction by Machine Learning

“…The performance of the RF-20 model for incident CHF prediction was better than the MESA-HF 15 risk score (C-index: 0·80, BS: 0·038) with a higher C-index and lower BS.…”

Clinical characteristics of HIV-infected patients with adjudicated heart failure

“…41,42 Diagnoses of probable HF required symptoms, diagnosis by a physician and HF medication use. Symptoms were defined as the presence of shortness of breath or lower extremity swelling.…”

Influence of diabetes on natriuretic peptide thresholds in screening for Stage B heart failure

“…Such a group are patients with features of asymptomatic left ventricular abnormalities (Stage B Heart Failure). Previous work from our unit and others have shown that, while limitations exist, natriuretic peptide (NP) is an effective screening tool to identify this population (Vasan et al, 2002, Murtagh et al, 2012, Lubien et al, 2002, Nadir et al, 2015, Chahal et al, 2015, Hebert et al, 2010. In addition, risk stratification with NP can facilitate strategies guided by NP, which have been shown to be effective in reducing new onset heart failure and other cardiovascular (CV) events , Huelsmann et al, 2013.…”