TY - JOUR
T1 - A population-based study of 92 clinically recognized risk factors for heart failure
T2 - co-occurrence, prognosis and preventive potential
AU - Banerjee, Amitava
AU - Pasea, Laura
AU - Chung, Sheng-Chia
AU - Direk, Kenan
AU - Asselbergs, Folkert
AU - Grobbee, Diederick E.
AU - Kotecha, Dipak
AU - Anker, Stefan D.
AU - Dyszynski, Tomasz
AU - Tyl, Benoît
AU - Denaxas, Spiros
AU - Lumbers, R. Thomas
AU - Hemingway, Harry
N1 - Funding Information: A.B. is supported by research funding from NIHR (NIHR200937), British Medical Association (TP Gunton award), AstraZeneca and UK Research and Innovation. D.K. is supported by grants from the National Institute for Health Research (NIHR CDF‐2015‐08‐074 RATE‐AF; NIHR HTA‐130280 DaRe2THINK; NIHR EME‐132974 DaRe2THINK‐NeuroVascular), the British Heart Foundation (PG/17/55/33087 and AA/18/2/34218), the European Society of Cardiology supported by educational grants from Boehringer Ingelheim/BMS‐Pfizer Alliance/Bayer/Daiichi Sankyo/Boston Scientific, the NIHR/University of Oxford Biomedical Research Centre and British Heart Foundation/University of Birmingham Accelerator Award (STEEER‐AF NCT04396418); and Amomed Pharma, IRCCS San Raffaele and Menarini (Beta‐blockers in Heart Failure Collaborative Group NCT0083244). H.H. is an National Institute for Health Research (NIHR) Senior Investigator and funded by the National Institute for Health Research University College London Hospitals Biomedical Research Centre. H.H.'s work is supported by: Health Data Research UK (grant No. LOND1), which is funded by the UK Medical Research Council, Engineering and Physical Sciences Research Council, Economic and Social Research Council, Department of Health and Social Care (England), Chief Scientist Office of the Scottish Government Health and Social Care Directorates, Health and Social Care Research and Development Division (Welsh Government), Public Health Agency (Northern Ireland), British Heart Foundation and Wellcome Trust. A.B., L.P., F.A., D.E.G., D.K., S.D.A., T.D., B.T., S.D., R.T.L. and H.H. are part of the BigData@Heart Consortium, funded by the Innovative Medicines Initiative‐2 Joint Undertaking under grant agreement No. 116074. This Joint Undertaking receives support from the European Union's Horizon 2020 research and innovation programme and EFPIA; it is chaired, by D.E.G. and S.D.A., partnering with 20 academic and industry partners and ESC. Publisher Copyright: © 2021 The Authors. European Journal of Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology.
PY - 2022/3/1
Y1 - 2022/3/1
N2 - Aims: Primary prevention strategies for heart failure (HF) have had limited success, possibly due to a wide range of underlying risk factors (RFs). Systematic evaluations of the prognostic burden and preventive potential across this wide range of risk factors are lacking. We aimed at estimating. evidence, prevalence and co-occurrence for primary prevention and impact on prognosis of RFs for incident HF. Methods and results: We systematically reviewed trials and observational evidence of primary HF prevention across 92 putative aetiologic RFs for HF identified from US and European clinical practice guidelines. We identified 170 885 individuals aged ≥30 years with incident HF from 1997 to 2017, using linked primary and secondary care UK electronic health records (EHR) and rule-based phenotypes (ICD-10, Read Version 2, OPCS-4 procedure and medication codes) for each of 92 RFs. Only 10/92 factors had high quality observational evidence for association with incident HF; 7 had effective randomized controlled trial (RCT)-based interventions for HF prevention (RCT-HF), and 6 for cardiovascular disease prevention, but not HF (RCT-CVD), and the remainder had no RCT-based preventive interventions (RCT-0). We were able to map 91/92 risk factors to EHR using 5961 terms, and 88/91 factors were represented by at least one patient. In the 5 years prior to HF diagnosis, 44.3% had ≥4 RFs. By RCT evidence, the most common RCT-HF RFs were hypertension (48.5%), stable angina (34.9%), unstable angina (16.8%), myocardial infarction (15.8%), and diabetes (15.1%); RCT-CVD RFs were smoking (46.4%) and obesity (29.9%); and RCT-0 RFs were atrial arrhythmias (17.2%), cancer (16.5%), heavy alcohol intake (14.9%). Mortality at 1 year varied across all 91 factors (lowest: pregnancy-related hormonal disorder 4.2%; highest: phaeochromocytoma 73.7%). Among new HF cases, 28.5% had no RCT-HF RFs and 38.6% had no RCT-CVD RFs. 15.6% had either no RF or only RCT-0 RFs. Conclusion: One in six individuals with HF have no recorded RFs or RFs without trials. We provide a systematic map of primary preventive opportunities across a wide range of RFs for HF, demonstrating a high burden of co-occurrence and the need for trials tackling multiple RFs.
AB - Aims: Primary prevention strategies for heart failure (HF) have had limited success, possibly due to a wide range of underlying risk factors (RFs). Systematic evaluations of the prognostic burden and preventive potential across this wide range of risk factors are lacking. We aimed at estimating. evidence, prevalence and co-occurrence for primary prevention and impact on prognosis of RFs for incident HF. Methods and results: We systematically reviewed trials and observational evidence of primary HF prevention across 92 putative aetiologic RFs for HF identified from US and European clinical practice guidelines. We identified 170 885 individuals aged ≥30 years with incident HF from 1997 to 2017, using linked primary and secondary care UK electronic health records (EHR) and rule-based phenotypes (ICD-10, Read Version 2, OPCS-4 procedure and medication codes) for each of 92 RFs. Only 10/92 factors had high quality observational evidence for association with incident HF; 7 had effective randomized controlled trial (RCT)-based interventions for HF prevention (RCT-HF), and 6 for cardiovascular disease prevention, but not HF (RCT-CVD), and the remainder had no RCT-based preventive interventions (RCT-0). We were able to map 91/92 risk factors to EHR using 5961 terms, and 88/91 factors were represented by at least one patient. In the 5 years prior to HF diagnosis, 44.3% had ≥4 RFs. By RCT evidence, the most common RCT-HF RFs were hypertension (48.5%), stable angina (34.9%), unstable angina (16.8%), myocardial infarction (15.8%), and diabetes (15.1%); RCT-CVD RFs were smoking (46.4%) and obesity (29.9%); and RCT-0 RFs were atrial arrhythmias (17.2%), cancer (16.5%), heavy alcohol intake (14.9%). Mortality at 1 year varied across all 91 factors (lowest: pregnancy-related hormonal disorder 4.2%; highest: phaeochromocytoma 73.7%). Among new HF cases, 28.5% had no RCT-HF RFs and 38.6% had no RCT-CVD RFs. 15.6% had either no RF or only RCT-0 RFs. Conclusion: One in six individuals with HF have no recorded RFs or RFs without trials. We provide a systematic map of primary preventive opportunities across a wide range of RFs for HF, demonstrating a high burden of co-occurrence and the need for trials tackling multiple RFs.
KW - Epidemiology
KW - Heart failure
KW - Primary prevention
KW - Risk factor
UR - http://www.scopus.com/inward/record.url?scp=85123617272&partnerID=8YFLogxK
U2 - https://doi.org/10.1002/ejhf.2417
DO - https://doi.org/10.1002/ejhf.2417
M3 - Article
C2 - 34969173
SN - 1388-9842
VL - 24
SP - 466
EP - 480
JO - European journal of heart failure
JF - European journal of heart failure
IS - 3
ER -