Rheumatic heart disease and risk of incident heart failure among community-dwelling older adults: a prospective cohort study.

Pubmed ID: 21254894

Pubmed Central ID: PMC3116996

Journal: Annals of medicine

Publication Date: May 1, 2012

MeSH Terms: Humans, Male, Female, Aged, Aged, 80 and over, Risk Factors, Logistic Models, Proportional Hazards Models, Heart Failure, Propensity Score, Prospective Studies, Follow-Up Studies, Incidence, Kaplan-Meier Estimate, Risk, Rheumatic Heart Disease

Grants: R01 HL085561, R01-HL085561, R01 HL085561-04, R01 HL097047, R01 HL097047-02, R01-HL097047

Authors: Ahmed MI, White M, Ekundayo OJ, Love TE, Aronow WS, Ahmed A, Mujib M, Desai RV, Feller MA, Aban IB, Deedwania P, Guichard JL, Rahimtoola SH, Ali M, Bonow RO

Cite As: Mujib M, Desai RV, Ahmed MI, Guichard JL, Feller MA, Ekundayo OJ, Deedwania P, Ali M, Aban IB, Love TE, White M, Aronow WS, Rahimtoola SH, Bonow RO, Ahmed A. Rheumatic heart disease and risk of incident heart failure among community-dwelling older adults: a prospective cohort study. Ann Med 2012 May;44(3):253-61. Epub 2011 Jan 24.

Studies:

Abstract

BACKGROUND: Little is known about the association of rheumatic heart disease (RHD) with incident heart failure (HF) among older adults. DESIGN: Cardiovascular Health Study, a prospective cohort study. METHODS: Of the 4,751 community-dwelling adults ≥ 65 years, free of prevalent HF at baseline, 140 had RHD, defined as self-reported physician-diagnosed RHD along with echocardiographic evidence of left-sided valvular disease. Propensity scores for RHD, estimated for each of the 4,751 participants, were used to assemble a cohort of 720, in which 124 and 596 participants with and without RHD, respectively, were balanced on 62 baseline characteristics. RESULTS: Incident HF developed in 33% and 22% of matched participants with and without RHD, respectively, during 13 years of follow-up (hazard ratio when RHD was compared to no-RHD 1.60; 95% confidence interval 1.13-2.28; P = 0.008). Pre-match unadjusted, multivariable-adjusted, and propensity-adjusted hazard ratios (95% confidence intervals) for RHD-associated incident heart failure were 2.04 (1.54-2.71; P < 0.001), 1.32 (1.02-1.70; P = 0.034), and 1.55 (1.14-2.11; P = 0.005), respectively. RHD was not associated with all-cause mortality (HR 1.09; 95% CI 0.82-1.45; P = 0.568). CONCLUSION: RHD is an independent risk factor for incident HF among community-dwelling older adults free of HF, but has no association with mortality.