Profile for estimating risk of heart failure

Context: We devised a risk appraisal function to assess the hazard of heart failure in persons who are predisposed by coronary disease, hypertension, or valvular heart disease. Objective: To provide general practitioners and internists with a cost-effe ctive method to select people at high risk who are likely to have impaired left ventricular systolic function and may therefore require further evalua tion and aggressive preventive measures. Methods: The routinely measured risk factors used in constructing the heart failure profile include age, electrocardiographic left ventricular hypertr ophy, cardiomegaly on chest x-ray film, heart rate, systolic blood pressure , vital capacity, diabetes mellitus, evidence of myocardial infarction, and valvular disease or hypertension. Based on 486 heart failure cases during 38 years of follow-up, 4-year probabilities of failure were computed using the pooled logistic regression model for each sex; a simple point score sys tem was employed. A multivariate profile was also produced without the vita l capacity or chest x-ray film because these may not be readily available i n some clinical settings. Results: Using the risk factors that make up the multivariate risk formulat ion-derived from ordinary office procedures-the probability of developing h eart failure can be estimated and compared with the average risk for person s of the same age and sex. Using this risk profile, 60% of events in men an d 73% in women occurred in subjects in the top quintile of multivariate ris k. Conclusions: Using this multivariate risk formulation, it is possible to id entify high-risk candidates for heart failure who are likely to have a subs tantial yield of positive findings when tested for objective evidence of pr esymptomatic left ventricular dysfunction. The risk profile may also identi fy candidates who are at high risk for heart failure because of multiple, m arginal risk factor abnormalities that might otherwise be overlooked.