10-Year Risk Equations for Incident Heart Failure in the General Population

Abstract

Primary prevention strategies to mitigate the burden of heart failure (HF) are urgently needed. However, no validated risk prediction tools are currently in use. We sought to derive 10-year risk equations of developing incident HF. Race- and sex-specific 10-year risk equations for HF were derived and validated from individual-level data from 7 community-based cohorts with at least 12 years of follow-up. Participants who were recruited between 1985-2000, between 30 to 80 years, and were free of cardiovascular disease at baseline were included to create a pooled cohort (PC) and randomly split for derivation and internal validation. Model performance was also assessed in 2 additional cohorts. In the derivation sample of the PC (n=11771), 58% were women, 22% were black with a mean age 52±12 years, and HF occurred in 1339 participants. Predictors of HF included in the race-sex specific models were age, blood pressure (treated or untreated), fasting glucose (treated or untreated), body mass index, cholesterol, smoking status, and QRS duration. The PC equations to Prevent HF (PCP-HF) model had good discrimination and strong calibration in internal and external validation cohorts. A web-based tool was developed to facilitate clinical application of this tool. We present a contemporary analysis from 33,010 men and women demonstrating the utility of the sex and race-specific 10-year PCP-HF risk score, which integrates clinical parameters readily available in primary care settings. This tool can be useful in risk-based decision making to determine who may merit intensive screening and/or targeted prevention strategies. There is an is urgent need to identify strategies to prevent heart failure given the substantial morbidity, mortality, and cost associated with HF. We developed the Pooled Cohort equations to Prevent HF (PCP-HF) to estimate 10-year risk of incident HF among participants aged 30-80 years from 5 population-based cohorts. We assessed model performance internally and validated it externally in 2 large cohorts. The PCP-HF risk score demonstrated good discrimination and calibration. The PCP-HF risk score is a novel tool that integrates clinical risk factor data and may be useful in individual level risk-based decision making and population-level prevention of HF.