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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.
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Acknowledgements
The Cardiovascular Health Study (CHS) was conducted and supported by the NHLBI in collaboration with the CHS Investigators. This manuscript was prepared using a public-use data set obtained from the NHLBI and does not necessarily reflect the opinions or views of the CHS or the NHLBI.
A. Ahmed conceived and designed the study. M. Mujib, R. Desai, M. I. Ahmed, and A. Ahmed analyzed and interpreted the data and drafted the manuscript. All authors interpreted the data, critically revised the draft, and gave final approval of the version to be published.
An abstract based on the current analysis was presented at an oral session at the American Heart Association 2009 Scientific Sessions in Orlando, Florida on 17 November 2009.
Declaration of interest: A. Ahmed is supported by the NIH through grants (R01-HL085561 and R01-HL097047) from the NHLBI and a generous gift from Ms Jean B. Morris of Birmingham, Alabama. The other authors declare no conflicts of interest.