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Original Articles

Incident Heart Failure Prediction in the Elderly

The Health ABC Heart Failure Score

Javed Butler, MD, MPH; Andreas Kalogeropoulos, MD; Vasiliki Georgiopoulou, MD; Rhonda Belue, PhD; Nicolas Rodondi, MD, MS; Melissa Garcia, MPH; Douglas C. Bauer, MD; Suzanne Satterfield, MD, DrPH; Andrew L. Smith, MD; Viola Vaccarino, MD, PhD; Anne B. Newman, MD, MPH; Tamara B. Harris, MD, MS; Peter W.F. Wilson, MD; Stephen B. Kritchevsky, PhD for the Health ABC Study

From Emory University, Atlanta, Ga (J.B., A.K., V.G., A.L.S., V.V., P.W.F.W.); Pennsylvania State University, Hershey, Pa (R.B.); University of Lausanne, Lausanne, Switzerland (N.R.); National Institute of Aging, National Institutes of Health, Bethesda, Md (M.G., T.B.H.); University of California San Francisco, San Francisco, Calif (D.C.B.); University of Memphis, Memphis, Tenn (S.S.); University of Pittsburgh, Pittsburgh, Pa (A.B.N.); Wake Forest University, Winston Salem, SC (S.B.K.).

Correspondence to Javed Butler, MD, MPH, Cardiology Division, Emory University Hospital, 1365 Clifton Road, NE, Suite AT430, Atlanta, GA 30322. E-mail javed.butler{at}emory.edu

Received January 24, 2008; accepted May 19, 2008.

Background— Despite the rising heart failure (HF) incidence and aging United States population, there are no validated prediction models for incident HF in the elderly. We sought to develop a new prediction model for 5-year risk of incident HF among older persons.

Methods and Results— Proportional hazards models were used to assess independent predictors of incident HF, defined as hospitalization for new-onset HF, in 2935 elderly participants without baseline HF enrolled in the Health ABC study (age, 73.6±2.9 years, 47.9% males, 58.6% whites). A prediction equation was developed and internally validated by bootstrapping, allowing the development of a 5-year risk score. Incident HF developed in 258 (8.8%) participants during 6.5±1.8 years of follow-up. Independent predictors of incident HF included age, history of coronary disease and smoking, baseline systolic blood pressure and heart rate, serum glucose, creatinine, and albumin levels, and left ventricular hypertrophy. The Health ABC HF model had a c-statistic of 0.73 in the derivation dataset, 0.72 by internal validation (optimism-corrected), and good calibration (goodness-of-fit ² 6.24, P=0.621). A simple point score was created to predict incident HF risk into 4 risk groups corresponding to <5%, 5% to 10%, 10% to 20%, and >20% 5-year risk. The actual 5-year incident HF rates in these groups were 2.9%, 5.7%, 13.3%, and 36.8%, respectively.

Conclusion— The Health ABC HF prediction model uses common clinical variables to predict incident HF risk in the elderly, an approach that may be used to target and treat high-risk individuals.

Key Words: heart failure • elderly • risk factors • statistical models • epidemiology

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CLINICAL PERSPECTIVE

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