Congestive Heart Failure

Congestive Heart Failure

Based on
Kannel WB, D’Agostino RB, Silbershatz H, Belanger AJ, Wilson PW, Levy D. Profile for estimating risk of heart failure. Archives of internal medicine. 1999 Jun 14;159(11):1197-204. PMID:10371227.

Outcome
Congestive Heart Failure

Duration of follow-up
Maximum of 38 years, 4-year risk prediction (pooled logistic regression)

Population of interest
Individuals 45 to 94 years old with coronary disease, hypertension or valvular disease

Predictors

  • Age
  • Left Ventricular Hypertrophy
  • Heart rate
  • Systolic Blood Pressure
  • Coronary Heart Disease
  • Valve Disease
  • Diabetes
  • BMI
  • Vital Capacity (some models)
  • Cardiomegaly (some models)

Probability of Congestive Heart Failure Within 4 Years for Men Aged 45 to 94 Years

With Coronary Disease, Hypertension, or Valvular Disease*
Model including vital capacity and chest x-ray results

Points
0 1 2 3 4
Age,y 45-49 50-54 55-59 60-64 65-69
Forced vital capacity, cL ≥425 375-424 325-374 275-324 200-274
Systolic blood pressure, mm Hg <120 120-139 140-169 170-189 190-219
Heart rate, bpm <55 55-64 65-79 80-89 90-99
LVH on ECG No
Coronary heart disease No
Valve disease No
Diabetes No Yes
Cardiomegaly No
Points
5 6 7 8 9
Age,y 70-74 75-79 80-89 90-94
Forced vital capacity, cL 150-199 ≤149
Systolic blood pressure, mm Hg >219
Heart rate, bpm >99
LVH on ECG Yes
Coronary heart disease Yes
Valve disease Yes
Diabetes
Cardiomegaly Yes
Points 4-Year Probability, % Points 4-Year Probability, %
5 1 26 18
10 1 27 21
12 2 28 24
14 3 29 27
16 4 30 31
18 5 31 34
20 7 33 38
22 10 33 42
24 14 34 47
25 16 35 51

*LVH indicates left ventricular hypertrophy; ECG, electrocardiogram.

Probability of Congestive Heart Failure Within 4 Years for Men Aged 45 to 94 Years

With Coronary Disease, Hypertension, or Valvular Disease*
Model without vital capacity and chest x-ray results

Points
0 1 2 3 4
Age, y 45-49 50-54 55-59 60-64 65-69
Systolic blood pressure, mm Hg <120 120-139 140-169 170-189 190-219
Heart rate, bpm <55 55-64 65-79 80-89 90-104
LVH on ECG No Yes
Coronary heart disease No
Valve disease No
Diabetes No Yes
Points
5 6 7 8 9
Age, y 70-74 75-79 80-84 85-89 90-94
Systolic blood pressure, mm Hg >219
Heart rate, bpm >104
LVH on ECG
Coronary heart disease Yes
Valve disease Yes
Diabetes
Points 4-Year Probability, % Points 4-Year Probability, %
5 1 24 30
10 3 25 34
12 3 26 39
14 5 27 44
16 8 28 49
18 11 29 54
20 16 30 59
22 22

*LVH indicates left ventricular hypertrophy; ECG, electrocardiogram.

Probability of Congestive Heart Failure Within 4 Years for Women Aged 45 to 94 Years

With Coronary Disease, Hypertension, or Valvular Disease*
Model including vital capacity and chest x-ray results

Points
0 1 2 3 4
Age, y 45-49 50-59 60-69 70-79 80-89
Forced vital capacity, cL >299 250-299 200-249 150-199 <150
Systolic blood pressure, mmHg <130 130-189 >189
Heart rate, bpm <55 55-79 80-99 >99
LVH on ECG No
Coronary Heart Disease No
Cardiomegaly No Yes
Valve Disease No
Diabetes (no valve disease) No
Diabetes (valve disease) No Yes
Points
5 6 7 8 9
Age, y 90-94
Forced vital capacity, cL
Systolic blood pressure, mmHg
Heart rate, bpm
LVH on ECG Yes
Coronary Heart Disease
Cardiomegaly Yes
Valve Disease Yes
Diabetes (no valve disease) Yes
Diabetes (valve disease)
Points 4-Year Probability, % Points 4-Year Probability, %
5 <1 26 18
10 1 27 21
12 1 28 24
14 2 29 28
16 3 30 32
18 4 31 37
20 6 32 42
22 9 33 46
24 13 34 51
25 15 35 56

*LVH indicates left ventricular hypertrophy; ECG, electrocardiogram.

Probability of Congestive Heart Failure Within 4 Years for Women Aged 45 to 94 Years

With Coronary Disease, Hypertension, or Valvular Disease*
Model without vital capacity and chest x-ray results

Points
0 1 2 3 4
Age, y 45-49 50-54 55-59 60-64 65-69
BMI, kg/m2 <21 21-25 26-29 >29 <150
Systolic blood pressure, mmHg <140 140-209 >209
Heart rate, bpm <60 60-79 80-104 >104
LVH on ECG No
Coronary Heart Disease No
Valve Disease No
Diabetes (no valve disease) No
Diabetes (valve disease) No Yes
Points
5 6 7 8 9
Age, y 70-74 75-79 80-84 85-89 90-94
BMI, kg/m2
Systolic blood pressure, mmHg
Heart rate, bpm
LVH on ECG Yes
Coronary Heart Disease Yes
Valve Disease Yes
Diabetes (no valve disease) Yes
Diabetes (valve disease)
Points 4-Year Probability, % Points 4-Year Probability, %
5 <1 19 14
10 2 20 17
11 2 21 21
12 3 22 25
13 3 23 30
14 4 24 36
15 5 25 42
16 7 26 48
17 9 27 54
18 11 28 60

*LVH indicates left ventricular hypertrophy; ECG, electrocardiogram.

Pooled Logistic Regression Model With Coefficients and Odds Ratios*

Model including vital capacity and chest x-ray information

Variables Units Regression
Coefficient		 OR (95% CI) P
Men
Intercept -7.3611
Age 10 y 0.0313 1.37 (1.17-1.60) <.001
LVH Yes/no 0.8428 2.32 (1.51-3.56) <.001
Vital capacity 100 cL -0.0030 0.74 (0.61-0.90) 0.003
Heart rate 10 bpm 0.0144 1.15 (1.05-1.27) 0.002
Systolic blood pressure 20 mm Hg 0.0067 1.14 (1.02-1.29) 0.03
CHD Yes/no 1.5333 4.63 (3.52-6.10) <.001
Valve disease Yes/no 0.8868 2.43 (1.73-3.41) <.001
Diabetes Yes/no 0.2383 1.27 (0.90-1.79) 0.17
Cardiomegaly Yes/no 0.7968 2.22 (1.63-3.01) <.001
Women
Intercept -5.4997
Age 10 y 0.0216 1.24 (1.06-1.45) 0.007
LVH Yes/no 1.0072 2.74 (1.78-4.22) <.001
Vital capacity 100 cL -0.0087 0.42 (0.33-0.55) <.001
Heart rate 10 bpm 0.0092 1.10 (0.99-1.21) 0.07
Systolic blood pressure 20 mm Hg 0.0032 1.07 (0.96-1.20) 0.24
CHD Yes/no 1.5358 4.64 (3.42-6.31) <.001
Valve disease Yes/no 1.2454 3.47 (2.46-4.92) <.001
Diabetes Yes/no 1.4275 4.17 (2.91-5.97) <.001
Cardiomegaly Yes/no 0.4792 1.61 (1.21-2.16) 0.001
Valve disease and diabetes Yes/no -0.9293 0.39 (0.19-0.83) 0.01

*OR indicates odds ratio; CI, confidence interval; LVH, left ventricular hypertrophy; and CHD,congenital heart disease.
Predicted probability of heart failure can be calculated as: p = 1/(1+exp(-xbeta)), where xbeta = Intercept + Sum (of regression coefficient*value of risk factor)

Pooled Logistic Regression Model With Coefficients and Odds Ratios*

Model without vital capacity and chest x-ray information

Variables Units Regression
Coefficient		 OR (95% CI) P
Men
Intercept -9.2087
Age 10 y 0.0412 1.51 (1.31-1.74) <.001
LVH Yes/no 0.9026 2.47 (1.31-3.77) <.001
Heart rate 10 bpm 0.0166 1.18 (1.08-1.29) <.001
Systolic blood pressure 20 mm Hg 0.00804 1.17 (1.04-1.32) 0.007
CHD Yes/no 1.6079 4.99 (3.80-6.55) <.001
Valve disease Yes/no 0.9714 2.64 (1.89-3.69) <.001
Diabetes Yes/no 0.2244 1.25 (0.89-1.76) 0.2
Women
Intercept -10.7988
Age 10 y 0.0503 1.65 (1.42-1.93) <.001
LVH Yes/no 1.3402 3.82 (2.50-5.83) <.001
Heart rate 100 cL 0.0105 1.11 (1.01-1.23) 0.03
Systolic blood pressure 10 bpm 0.00337 1.07 (0.96-1.20) 0.24
CHD 20 mm Hg 1.5549 4.74 (3.49-6.42) <.001
Valve disease Yes/no 1.3929 4.03 (2.86-5.67) <.001
Diabetes Yes/no 1.3857 4.00 (2.78-5.74) <.001
BMI kg/m2 0.0578 1.06 (1.03-1.09) <.001
Valve disease and diabetes Yes/no -0.9860 0.37 (0.18-0.78) 0.009

*OR indicates odds ratio; CI, confidence interval; LVH, left ventricular hypertrophy; CHD, congenital heart disease; and BMI, body mass index. Predicted probability of heart failure can be calculated as: p = 1/(1+exp(-xbeta)), where xbeta = Intercept + Sum (of regression coefficient*value of risk factor)