Predictors of Incident Heart Failure in a Large Insured Population

Abstract

Background Studies on the incidence and predictors of heart failure (HF) are often restricted to elderly persons or identify only inpatient cases. Methods and Results We determined the incidence and predictors of new HF diagnosed in either outpatient or inpatient settings, among 359 947 women and men (age ≥18 years) insured by Kaiser Permanente Georgia at any time during calendar years 2000 to 2005. Subjects were free of HF at baseline, and incident HF was identified with ICD-9 codes (1 inpatient or 2 outpatient HF visits). We developed multivariable Cox models to assess the association of antecedent factors (coronary heart disease, hypertension, diabetes mellitus, atrial fibrillation, and valvular heart disease) with incident HF. Separate models were created for each sex and for newly diagnosed HF in outpatient or inpatient settings. There were 4001 incident HF cases (50% women and 48% in subjects <65 years old), during 1 015 794 person-years of follow-up. The incidence rate of HF was greater in men than in women (4.24 versus 3.68 per 1000 person-years) but was stable across the study interval in both sexes. Two thirds of incident HF cases from this population occurred in outpatients. These 5 antecedent factors and age yielded excellent discrimination for incident HF in both outpatients and inpatients and in both sexes (C >0.85 in all models). Conclusions Common modifiable risk factors accurately discriminate women and men at risk for HF diagnosed in either outpatient or inpatient settings. Approximately two thirds of new HF cases in our insured population were diagnosed in outpatients; more research is needed to characterize these subjects and their prognosis.

Effects of Physical Activity and Sedentary Time on the Risk of Heart Failure

“…HF was identified from electronic records using the criteria described by Goyal et al, 27 including ≥1 hospitalization with an ICD-9 diagnosis code of HF (codes 402.X1, 404.X1, 404.X3, and 428.XX) or ≥2 outpatient diagnoses of HF. Validity of an inpatient discharge diagnosis of HF was assessed from 200 randomly selected hospital charts to determine the extent to which Framingham criteria for HF were met; results indicated a positive predictive value of 97%.…”

“…28 Outpatient diagnosis codes may be less accurate; hence, we required ≥2 separate outpatient diagnoses. 27 In a systematic review of validated methods for identifying HF using administrative data, Saczynski et al 29 recommended, including outpatient codes, to maximize sensitivity because many patients with HF are identified and managed in the outpatient setting. Incident cases were defined as receiving a diagnosis from baseline to May 1, 2012.…”

Valvular Heart Disease in Circulation and the Circulation Subspecialty Journals

“…Approximately two thirds of new HF cases in our insured population were diagnosed in outpatients; more research is needed to characterize these subjects and their prognosis. 27 …”

MicroRNA and Its Role in Cardiovascular Disease

“…According to Health Management Organization, Kaiser Permanente Coronary artery disease, hypertension, diabetes mellitus, atrial fibrillation and valvular heart disease are the five major factors contributing heart failure [52].…”