Predictors of congestive heart failure in the elderly

The cardiovascular health study

John S. Gottdiener, Alice M. Arnold, Gerard P. Aurigemma, Joseph F. Polak, Russell P. Tracy, Dalane W. Kitzman, Julius M. Gardin, John C Rutledge, Robin C. Boineau

Research output: Contribution to journalArticle

637 Citations (Scopus)

Abstract

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 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. (C) 2000 by the American College of Cardiology.

Original languageEnglish (US)
Pages (from-to)1628-1637
Number of pages10
JournalJournal of the American College of Cardiology
Volume35
Issue number6
DOIs
StatePublished - May 2000

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Heart Failure
Health
Blood Pressure
Atrial Fibrillation
Coronary Disease
C-Reactive Protein
Population
Independent Living
Transient Ischemic Attack
Incidence
Forced Expiratory Volume
Internal Carotid Artery
Ankle
Creatinine
Arm
Multivariate Analysis
Age Groups
Heart Rate
Stroke
Prospective Studies

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Gottdiener, J. S., Arnold, A. M., Aurigemma, G. P., Polak, J. F., Tracy, R. P., Kitzman, D. W., ... Boineau, R. C. (2000). Predictors of congestive heart failure in the elderly: The cardiovascular health study. Journal of the American College of Cardiology, 35(6), 1628-1637. https://doi.org/10.1016/S0735-1097(00)00582-9

Predictors of congestive heart failure in the elderly : The cardiovascular health study. / Gottdiener, John S.; Arnold, Alice M.; Aurigemma, Gerard P.; Polak, Joseph F.; Tracy, Russell P.; Kitzman, Dalane W.; Gardin, Julius M.; Rutledge, John C; Boineau, Robin C.

In: Journal of the American College of Cardiology, Vol. 35, No. 6, 05.2000, p. 1628-1637.

Research output: Contribution to journalArticle

Gottdiener, JS, Arnold, AM, Aurigemma, GP, Polak, JF, Tracy, RP, Kitzman, DW, Gardin, JM, Rutledge, JC & Boineau, RC 2000, 'Predictors of congestive heart failure in the elderly: The cardiovascular health study', Journal of the American College of Cardiology, vol. 35, no. 6, pp. 1628-1637. https://doi.org/10.1016/S0735-1097(00)00582-9
Gottdiener, John S. ; Arnold, Alice M. ; Aurigemma, Gerard P. ; Polak, Joseph F. ; Tracy, Russell P. ; Kitzman, Dalane W. ; Gardin, Julius M. ; Rutledge, John C ; Boineau, Robin C. / Predictors of congestive heart failure in the elderly : The cardiovascular health study. In: Journal of the American College of Cardiology. 2000 ; Vol. 35, No. 6. pp. 1628-1637.
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abstract = "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 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. (C) 2000 by the American College of Cardiology.",
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AU - Arnold, Alice M.

AU - Aurigemma, Gerard P.

AU - Polak, Joseph F.

AU - Tracy, Russell P.

AU - Kitzman, Dalane W.

AU - Gardin, Julius M.

AU - Rutledge, John C

AU - Boineau, Robin C.

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N2 - 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 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. (C) 2000 by the American College of Cardiology.

AB - 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 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. (C) 2000 by the American College of Cardiology.

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