Development and Validation of a Long-Term Incident Heart Failure Risk Model

Sadiya S. Khan*, Hongyan Ning, Norrina B. Allen, Mercedes R. Carnethon, Clyde W. Yancy, Sanjiv J. Shah, John T. Wilkins, Lu Tian, Donald M. Lloyd-Jones

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

16 Scopus citations

Abstract

BACKGROUND: Average lifetime risk for heart failure (HF) is high but differs significantly across and within sex-race groups. No models for estimating long-term risk for HF exist, which would allow for earlier identification and interventions in high-risk subsets. The authors aim to derive 30-year HF risk equations. METHODS: Adults between the ages of 20 to 59 years and free of cardiovascular disease at baseline from 5 population-based cohorts were included. Among 24 838 participants (55% women, 25% Black based on self-report), follow-up consisted of 599 551 person-years. Sex- and race-specific 30-year HF risk equations were derived and validated accounting for competing risk of non-HF death. HF was based on a clinical diagnosis. Model discrimination and calibration were assessed using 10-fold cross-validation. Finally, the model was applied to varying risk factor patterns for systematic examination. RESULTS: The rate of incident HF was 4.0 per 1000 person-years. Harrell C statistics were 0.82 (0.80-0.83) and 0.84 (0.82-0.85) in White and Black men and 0.84 (0.82-0.85) and 0.85 (0.83-0.87) in White and Black women, respectively. Hosmer-Lemeshow calibration was acceptable, with χ2 <30 in all subgroups. Risk estimation varied across sex-race groups: For example, in an average 40-year-old nonsmoker with an untreated systolic blood pressure of 140 mm Hg and body mass index of 30 kg/m2, risk was estimated to be 22.8% in a Black man, 13.7% in a White man, 13.0% in a Black woman, and 12.1% in a White woman. CONCLUSIONS: Sex- and race-specific equations for prediction of long-term risk of HF demonstrated high discrimination and adequate calibration.

Original languageEnglish (US)
Pages (from-to)200-209
Number of pages10
JournalCirculation research
Volume130
Issue number2
DOIs
StatePublished - Jan 21 2022

Funding

Research reported in this publication was supported, in part, by the National Institutes of Health\u2019s National Center for Advancing Translational Sciences (KL2TR001424), the National Heart Lung and Blood Institute (R01HL159250 and U01HL160279), and the American Heart Association (19TPA34890060) to S.S. Khan, as well as a grant from the National Institutes of Health/National Heart, Lung, and Blood Institute to D.M. Lloyd-Jones (R21 HL085375). Funders were not directly involved in the study design, data collection, analysis and interpretation, or drafting of this report. We confirm the independence of researchers from funders and that all authors had full access to all of the data in the study and can take responsibility for the integrity of the data and the accuracy of the data analysis.

Keywords

  • Adult
  • Female
  • Humans
  • Male
  • Young adult

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

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