CLINICAL STUDIES
Predictors of congestive heart failure in the elderly: the cardiovascular health study
John S. Gottdiener, MD, FACC* j,
Alice M. Arnold, PhD ,
Gerard P. Aurigemma, MD, FACC ,
Joseph F. Polak, MD ,
Russell P. Tracy, PhD||,
Dalane W. Kitzman, MD, FACC¶,
Julius M. Gardin, MD, FACC#,
John E. Rutledge, MD, FACC** and
Robin C. Boineau, MD
* Division of Cardiology, Georgetown University Hospital, Washington, DC, USA
j St. Francis Hospital, Roslyn, New York, USA
Department of Biostatistics, Washington University, Seattle, Washington, USA
Division of Cardiology, University of Massachusetts Medical Center, Worcester, Massachusetts, USA
Department of Radiology, Tufts–New England Medical Center, Boston, Massachusetts, USA
|| Colchester Research Facility, University of Vermont, Colchester, Vermont, USA
¶ Wake Forest University, Winston-Salem, North Carolina, USA
# University of California at Irvine, Irvine, California, USA
** Division of Cardiovascular Medicine, University of California at Davis, Davis, California, USA
Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Maryland, USA
Manuscript received April 2, 1999;
revised manuscript received December 7, 1999,
accepted January 19, 2000.
Reprint requests and correspondence: Dr. John S. Gottdiener, Cardiology Research, St. Francis Hospital, 100 Port Washington Boulevard, Roslyn, New York 11576
gottdien{at}ziplink.net
OBJECTIVES
We sought to characterize the predictors of incident congestive heart failure (CHF), as determined by central adjudication, in a community-based elderly population.
BACKGROUND
The elderly constitute a growing proportion of patients admitted to the hospital with CHF, and CHF is a leading source of morbidity and mortality in this group. Elderly patients differ from younger individuals diagnosed with CHF in terms of biologic characteristics.
METHODS
We analyzed data from the Cardiovascular Health Study, a prospective population-based study of 5,888 elderly people >65 years old (average 73 ± 5, range 65 to 100) at four locations. Multiple laboratory measures of cardiovascular structure and function, blood chemistries and functional assessments were obtained.
RESULTS
During an average follow-up of 5.5 years (median 6.3), 597 participants developed incident CHF (rate 19.3/1,000 person-years). The incidence of CHF increased progressively across age groups and was greater in men than in women. On multivariate analysis, other independent predictors included prevalent coronary heart disease, stroke or transient ischemic attack at baseline, diabetes, systolic blood pressure (BP), forced expiratory volume 1 s, creatinine >1.4 mg/dl, C-reactive protein, ankle-arm index <0.9, atrial fibrillation, electrocardiographic (ECG) left ventricular (LV) mass, ECG ST-T segment abnormality, internal carotid artery wall thickness and decreased LV systolic function. Population-attributable risk, determined from predictors of risk and prevalence, was relatively high for prevalent coronary heart disease (13.1%), systolic BP  140 mm Hg (12.8%) and a high level of C-reactive protein (9.7%), but was low for subnormal LV function (4.1%) and atrial fibrillation (2.2%).
CONCLUSIONS
The incidence of CHF is high in the elderly and is related mainly to age, gender, clinical and subclinical coronary heart disease, systolic BP and inflammation. Despite the high relative risk of subnormal systolic LV function and atrial fibrillation, the actual population risk of these for CHF is small because of their relatively low prevalence in community-dwelling elderly people.
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Abbreviations and Acronyms
| | BP | = blood pressure | | CHF | = congestive heart failure | | CHS | = Cardiovascular Health Study | | ECG | = electrocardiogram or electrocardiographic | | FEV1 | = forced expiratory volume in 1 s | | FVC | = forced vital capacity | | LV | = left ventricle or ventricular | | TIA | = transient ischemic attack |
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[Full Text]
[PDF]
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I. S. Anand, R. Latini, V. G. Florea, M. A. Kuskowski, T. Rector, S. Masson, S. Signorini, P. Mocarelli, A. Hester, R. Glazer, et al.
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Circulation,
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[Abstract]
[Full Text]
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A. V. Doobay and S. S. Anand
Sensitivity and Specificity of the Ankle-Brachial Index to Predict Future Cardiovascular Outcomes: A Systematic Review
Arterioscler Thromb Vasc Biol,
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[Abstract]
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D. Mozaffarian, C. L. Bryson, R. N. Lemaitre, G. L. Burke, and D. S. Siscovick
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45(12):
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[Abstract]
[Full Text]
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R. Vanholder, Z. Massy, A. Argiles, G. Spasovski, F. Verbeke, N. Lameire, and for the European Uremic Toxin Work Group (EUTox)
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[Abstract]
[Full Text]
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M. J. Sarnak, R. Katz, C. O. Stehman-Breen, L. F. Fried, N. S. Jenny, B. M. Psaty, A. B. Newman, D. Siscovick, M. G. Shlipak, and and the Cardiovascular Health Study*
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[Abstract]
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G. L. Smith, M. G. Shlipak, E. P. Havranek, F. A. Masoudi, W. M. McClellan, J. M. Foody, S. S. Rathore, and H. M. Krumholz
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Circulation,
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[Abstract]
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M. A. Arias, A. Alonso, F. Garcia-Rio, G. P. Aurigemma, and W. H. Gaasch
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D. J. Campbell, M. Woodward, J. P. Chalmers, S. A. Colman, A. J. Jenkins, B. E. Kemp, B. C. Neal, A. Patel, and S. W. MacMahon
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Hypertension,
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[Abstract]
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J. Arnlov, E. Ingelsson, U. Riserus, B. Andren, and L. Lind
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J. M. Gardin and M. S. Lauer
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JAMA,
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G. D. Schellenbaum, T. D. Rea, S. R. Heckbert, N. L. Smith, T. Lumley, V. L. Roger, D. W. Kitzman, H. A. Taylor, D. Levy, and B. M. Psaty
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G. P. Aurigemma and W. H. Gaasch
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G. S. Bleumink, A. M. Knetsch, M. C.J.M. Sturkenboom, S. M.J.M. Straus, A. Hofman, J. W. Deckers, J. C.M. Witteman, and B. H.Ch. Stricker
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G. A. Nichols, C. M. Gullion, C. E. Koro, S. A. Ephross, and J. B. Brown
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Diabetes Care,
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M. H. Drazner, J. E. Rame, E. K. Marino, J. S. Gottdiener, D. W. Kitzman, J. M. Gardin, T. A. Manolio, D. L. Dries, and D. S. Siscovick
Increased left ventricular mass is a risk factor for the development of a depressed left ventricular ejection fraction within five years: The Cardiovascular Health Study
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J. I. Barzilay, R. A. Kronmal, J. S. Gottdiener, N. L. Smith, G. L. Burke, R. Tracy, P. J. Savage, and M. Carlson
The association of fasting glucose levels with congestive heart failure in diabetic adults >=65 years: The Cardiovascular Health Study
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F A McAlister, N F Murphy, C R Simpson, S Stewart, K MacIntyre, M Kirkpatrick, J Chalmers, A Redpath, S Capewell, and J J V McMurray
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M. Jessup and I. L. Pina
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A. G. Bertoni, W. G. Hundley, M. W. Massing, D. E. Bonds, G. L. Burke, and D. C. Goff Jr.
Heart Failure Prevalence, Incidence, and Mortality in the Elderly With Diabetes
Diabetes Care,
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[Abstract]
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M. J. Sarnak, A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, B. L. Kasiske, E. Kelepouris, M. J. Klag, et al.
Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention
Hypertension,
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M. J. Sarnak, A. S. Levey, A. C. Schoolwerth, J. Coresh, B. Culleton, L. L. Hamm, P. A. McCullough, B. L. Kasiske, E. Kelepouris, M. J. Klag, et al.
Kidney Disease as a Risk Factor for Development of Cardiovascular Disease: A Statement From the American Heart Association Councils on Kidney in Cardiovascular Disease, High Blood Pressure Research, Clinical Cardiology, and Epidemiology and Prevention
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D. Johnson, Y. Jin, H. Quan, and B. Cujec
Beta-blockers and angiotensin-converting enzyme inhibitors/receptor blockers prescriptions after hospital discharge for heart failure are associated with decreased mortality in Alberta, Canada
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B. M. Massie
Natriuretic peptide measurements for the diagnosis of "nonsystolic" heart failure: Good news and bad
J. Am. Coll. Cardiol.,
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L. F. Fried, M. G. Shlipak, C. Crump, A. J. Bleyer, J. S. Gottdiener, R. A. Kronmal, L. H. Kuller, and A. B. Newman
Renal insufficiency as a predictor of cardiovascular outcomes and mortality in elderly individuals
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I. L. Pina, C. S. Apstein, G. J. Balady, R. Belardinelli, B. R. Chaitman, B. D. Duscha, B. J. Fletcher, J. L. Fleg, J. N. Myers, and M. J. Sullivan
Exercise and Heart Failure: A Statement From the American Heart Association Committee on Exercise, Rehabilitation, and Prevention
Circulation,
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E. Vittinghoff, M. G. Shlipak, P. D. Varosy, C. D. Furberg, C. C. Ireland, S. S. Khan, R. Blumenthal, E. Barrett-Connor, S. Hulley, and for the Heart and Estrogen/progestin Replacement S
Risk Factors and Secondary Prevention in Women with Heart Disease: The Heart and Estrogen/progestin Replacement Study
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P A Henriksen and D E Newby
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Heart,
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D. W. Kitzman, W. C. Little, P. H. Brubaker, R. T. Anderson, W. G. Hundley, C. T. Marburger, B. Brosnihan, T. M. Morgan, and K. P. Stewart
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J. S. Gottdiener, R. L. McClelland, R. Marshall, L. Shemanski, C. D. Furberg, D. W. Kitzman, M. Cushman, J. Polak, J. M. Gardin, B. J. Gersh, et al.
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F. N. Witherow, P. Dawson, C. A. Ludlam, K. A. A. Fox, and D. E. Newby
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R. O. Bonow, W. E. Mitch, R. W. Nesto, P. T. O'Gara, R. C. Becker, L. T. Clark, S. Hunt, I. Jialal, S. E. Lipshultz, and E. Loh
Prevention Conference VI: Diabetes and Cardiovascular Disease: Writing Group V: Management of Cardiovascular-Renal Complications
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M. R. Zile and D. L. Brutsaert
New Concepts in Diastolic Dysfunction and Diastolic Heart Failure: Part I: Diagnosis, Prognosis, and Measurements of Diastolic Function
Circulation,
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W.C. Little
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Eur. Heart J.,
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M. W. Rich, F. McSherry, W. O. Williford, S. Yusuf, and for the Digitalis Investigation Group
Effect of age on mortality, hospitalizations and response to digoxin in patients with heart failure: the DIG study
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G. A. Nichols, T. A. Hillier, J. R. Erbey, and J. B. Brown
Congestive Heart Failure in Type 2 Diabetes: Prevalence, incidence, and risk factors
Diabetes Care,
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M. W. Rich
Heart Failure in the 21st Century: A Cardiogeriatric Syndrome
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