Association of electrocardiogram abnormalities and incident heart failure events.
- Gencer B Cardiology Division, Department of Medicine, Geneva University Hospital, Geneva, Switzerland.
- Butler J Cardiology Division, Emory University, Atlanta, GA.
- Bauer DC Department of Medicine, University of California, San Francisco, CA; Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
- Auer R Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
- Kalogeropoulos A Cardiology Division, Emory University, Atlanta, GA.
- Marques-Vidal P Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland; Clinical Research Centre, Lausanne University Hospital, Lausanne, Switzerland.
- Applegate WB Internal Medicine and Geriatric Medicine, Wake Forest University Baptist Medical Center, Winston Salem, NC.
- Satterfield S Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, TN.
- Harris T Geriatric Epidemiology Section, National Institute on Aging, Bethesda, MD.
- Newman A Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA.
- Vittinghoff E Department of Epidemiology and Biostatistics, University of California, San Francisco, CA.
- Rodondi N Department of General Internal Medicine, University of Bern, Bern, Switzerland. Electronic address: Nicolas.Rodondi@insel.ch.
- 2014-06-04
Published in:
- American heart journal. - 2014
Age Factors
Aged
Aged, 80 and over
Arrhythmias, Cardiac
Cohort Studies
Coronary Disease
Diabetes Mellitus
Electrocardiography
Female
Heart Failure
Humans
Hypertension
Incidence
Longitudinal Studies
Male
Proportional Hazards Models
Prospective Studies
Risk Assessment
English
UNLABELLED
Unless effective preventive strategies are implemented, aging of the population will result in a significant worsening of the heart failure (HF) epidemic. Few data exist on whether baseline electrocardiographic (ECG) abnormalities can refine risk prediction for HF.
METHODS
We examined a prospective cohort of 2,915 participants aged 70 to 79 years without preexisting HF, enrolled between April 1997 and June 1998 in the Health, Aging, and Body Composition (Health ABC) study. Minnesota Code was used to define major and minor ECG abnormalities at baseline and at year 4 follow-up. Using Cox models, we assessed (1) the association between ECG abnormalities and incident HF and (2) the incremental value of adding ECG to the Health ABC HF Risk Score using the net reclassification index.
RESULTS
At baseline, 380 participants (13.0%) had minor, and 620 (21.3%) had major ECG abnormalities. During a median follow-up of 11.4 years, 485 participants (16.6%) developed incident HF. After adjusting for the Health ABC HF Risk Score variables, the hazard ratio (HR) was 1.27 (95% CI 0.96-1.68) for minor and 1.99 (95% CI 1.61-2.44) for major ECG abnormalities. At year 4, 263 participants developed new and 549 had persistent abnormalities; both were associated with increased subsequent HF risk (HR 1.94, 95% CI 1.38-2.72 for new and HR 2.35, 95% CI 1.82-3.02 for persistent ECG abnormalities). Baseline ECG correctly reclassified 10.5% of patients with HF events, 0.8% of those without HF events, and 1.4% of the overall population. The net reclassification index across the Health ABC HF risk categories was 0.11 (95% CI 0.03-0.19).
CONCLUSIONS
Among older adults, baseline and new ECG abnormalities are independently associated with increased risk of HF. The contribution of ECG screening for targeted prevention of HF should be evaluated in clinical trials.
Unless effective preventive strategies are implemented, aging of the population will result in a significant worsening of the heart failure (HF) epidemic. Few data exist on whether baseline electrocardiographic (ECG) abnormalities can refine risk prediction for HF.
METHODS
We examined a prospective cohort of 2,915 participants aged 70 to 79 years without preexisting HF, enrolled between April 1997 and June 1998 in the Health, Aging, and Body Composition (Health ABC) study. Minnesota Code was used to define major and minor ECG abnormalities at baseline and at year 4 follow-up. Using Cox models, we assessed (1) the association between ECG abnormalities and incident HF and (2) the incremental value of adding ECG to the Health ABC HF Risk Score using the net reclassification index.
RESULTS
At baseline, 380 participants (13.0%) had minor, and 620 (21.3%) had major ECG abnormalities. During a median follow-up of 11.4 years, 485 participants (16.6%) developed incident HF. After adjusting for the Health ABC HF Risk Score variables, the hazard ratio (HR) was 1.27 (95% CI 0.96-1.68) for minor and 1.99 (95% CI 1.61-2.44) for major ECG abnormalities. At year 4, 263 participants developed new and 549 had persistent abnormalities; both were associated with increased subsequent HF risk (HR 1.94, 95% CI 1.38-2.72 for new and HR 2.35, 95% CI 1.82-3.02 for persistent ECG abnormalities). Baseline ECG correctly reclassified 10.5% of patients with HF events, 0.8% of those without HF events, and 1.4% of the overall population. The net reclassification index across the Health ABC HF risk categories was 0.11 (95% CI 0.03-0.19).
CONCLUSIONS
Among older adults, baseline and new ECG abnormalities are independently associated with increased risk of HF. The contribution of ECG screening for targeted prevention of HF should be evaluated in clinical trials.
- Language
-
- English
- Open access status
- green
- Identifiers
-
- DOI 10.1016/j.ahj.2014.03.020
- PMID 24890537
- Persistent URL
- https://sonar.ch/global/documents/279311
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