Predicting heart failure with preserved and reduced ejection fraction: The international collaboration on heart failure subtypes

Jennifer E Ho, Danielle Enserro, Frank P Brouwers, Jorge R Kizer, Sanjiv J Shah, Bruce M Psaty, Traci M Bartz, Rajalakshmi Santhanakrishnan, Douglas S Lee, Cheeling Chan, Kiang Liu, Michael J Blaha, Hans L Hillege, Pim van der Harst, Wiek H van Gilst, W.J. Kop, Ron T Gansevoort, Ramachandran S Vasan, Julius M Gardin, Daniel LevyJohn S Gottdiener, Rudolf A de Boer, Martin G Larson

Research output: Contribution to journalArticleScientificpeer-review

75 Citations (Scopus)

Abstract

Background
Heart failure (HF) is a prevalent and deadly disease, and preventive strategies focused on at-risk individuals are needed. Current HF prediction models have not examined HF subtypes. We sought to develop and validate risk prediction models for HF with preserved and reduced ejection fraction (HFpEF, HFrEF).
Methods and Results
Of 28,820 participants from 4 community-based cohorts, 982 developed incident HFpEF and 909 HFrEF during a median follow-up of 12 years. Three cohorts were combined, and a 2:1 random split was used for derivation and internal validation, with the fourth cohort as external validation. Models accounted for multiple competing risks (death, other HF subtype, and unclassified HF). The HFpEF-specific model included age, sex, systolic blood pressure, body mass index, antihypertensive treatment, and previous myocardial infarction; it had good discrimination in derivation (c-statistic 0.80; 95% confidence interval [CI], 0.78–0.82) and validation samples (internal: 0.79; 95% CI, 0.77–0.82 and external: 0.76; 95% CI: 0.71–0.80). The HFrEF-specific model additionally included smoking, left ventricular hypertrophy, left bundle branch block, and diabetes mellitus; it had good discrimination in derivation (c-statistic 0.82; 95% CI, 0.80–0.84) and validation samples (internal: 0.80; 95% CI, 0.78–0.83 and external: 0.76; 95% CI, 0.71–0.80). Age was more strongly associated with HFpEF, and male sex, left ventricular hypertrophy, bundle branch block, previous myocardial infarction, and smoking with HFrEF (P value for each comparison ≤0.02).
Conclusions
We describe and validate risk prediction models for HF subtypes and show good discrimination in a large sample. Some risk factors differed between HFpEF and HFrEF, supporting the notion of pathogenetic differences among HF subtypes.
Original languageEnglish
Article numbere003116
JournalCirculation. Heart Failure
Volume9
Issue number6
DOIs
Publication statusPublished - Jun 2016

Fingerprint Dive into the research topics of 'Predicting heart failure with preserved and reduced ejection fraction: The international collaboration on heart failure subtypes'. Together they form a unique fingerprint.

  • Cite this

    Ho, J. E., Enserro, D., Brouwers, F. P., Kizer, J. R., Shah, S. J., Psaty, B. M., Bartz, T. M., Santhanakrishnan, R., Lee, D. S., Chan, C., Liu, K., Blaha, M. J., Hillege, H. L., van der Harst, P., van Gilst, W. H., Kop, W. J., Gansevoort, R. T., Vasan, R. S., Gardin, J. M., ... Larson, M. G. (2016). Predicting heart failure with preserved and reduced ejection fraction: The international collaboration on heart failure subtypes. Circulation. Heart Failure, 9(6), [e003116]. https://doi.org/10.1161/CIRCHEARTFAILURE.115.003116