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

Figures & data

Figure 1. Absolute standardized differences before and after propensity score matching comparing covariate values between rheumatic heart disease (RHD) and non-RHD participants. (ACE = angiotensin-converting enzyme; CABG = coronary artery by-pass surgery; COPD = chronic obstructive pulmonary disease; LV = left ventricular; NSAID = non-steroidal anti-inflammatory drug).

Table I. Baseline characteristics, by rheumatic heat disease (RHD), before and after propensity score matching.

	Before matching			After matching
n (%) or mean (±SD)	No RHD (n = 4611)	RHD (n = 140)	P value	No RHD (n = 596)	RHD (n = 124)	P value
Age, years	73 (±6)	73 (±5)	0.881	73 (±5)	73 (±5)	0.811
Female	2623 (57%)	85 (61%)	0.367	342 (57%)	73 (59%)	0.760
African-American	214 (5%)	1 (1%)	0.028	6 (1%)	1 (1%)	0.836
Married	3209 (70%)	94 (67%)	0.535	392 (66%)	86 (69%)	0.442
Living alone	453 (10%)	11 (8%)	0.440	66 (11%)	11 (9%)	0.470
College or higher education	2032 (44%)	78 (56%)	0.006	333 (56%)	68 (55%)	0.833
Income ≥$25 thousand /year	1780 (39%)	58 (41%)	0.499	243 (41%)	52 (42%)	0.811
Self-reported fair to poor general health	963 (21%)	41 (29%)	0.016	174 (29%)	35 (28%)	0.829
Current smoker	549 (12%)	14 (10%)	0.492	66 (11%)	14 (11%)	0.944
Smoking, pack years	18 (±27)	16 (±24)	0.358	17 (±26)	16 (±24)	0.847
Alcohol, drinks per week	3 (±6)	2 (±5)	0.484	2 (±6)	2 (±5)	0.971
Past medical history
Coronary artery disease	771 (17%)	38 (27%)	0.001	150 (25%)	33 (27%)	0.737
Myocardial infarction	361 (8%)	20 (14%)	0.006	76 (13%)	15 (12%)	0.842
Hypertension	2583 (56%)	79 (56%)	0.923	337 (57%)	70 (57%)	0.985
Diabetes mellitus	676 (15%)	17 (12%)	0.406	74 (12%)	11 (9%)	0.266
Transient ischemic attack	105 (2%)	7 (5%)	0.036	17 (3%)	4 (3%)	0.822
Stroke	156 (3%)	9 (6%)	0.053	27 (5%)	3 (2%)	0.285
Peripheral arterial disease	525 (11%)	17 (12%)	0.781	72 (12%)	14 (11%)	0.805
Chronic obstructive pulmonary disease	574 (12%)	21 (15%)	0.369	91 (15%)	20 (16%)	0.809
Arthritis	2314 (50%)	83 (59%)	0.034	373 (63%)	74 (60%)	0.544
Cancer	687 (15%)	32 (23%)	0.010	115 (19%)	27 (22%)	0.528
Clinical examination
Body mass index, kg/m^2	26 (±4)	25 (±4)	0.001	26 (±4)	25 (±4)	0.314
Pulse, beats per minute	68 (±11)	65 (±11)	0.002	65 (±10)	65 (±11)	0.820
Systolic BP, mmHg	136 (±21)	135 (±20)	0.848	135 (±22)	136 (±20)	0.691
Diastolic BP, mmHg	70 (±11)	68 (±11)	0.008	68 (±11)	68 (±11)	0.789
Medications
ACE inhibitors	240 (5%)	9 (6%)	0.522	30 (5%)	8 (7%)	0.521
Beta-blockers	590 (13%)	32 (23%)	0.001	137 (23%)	30 (24%)	0.772
Calcium channel blockers	455 (10%)	33 (24%)	<0.001	120 (20%)	25 (20%)	0.995
Digoxin	276 (6%)	36 (26%)	<0.001	104 (17%)	22 (18%)	0.938
Aspirin	2149 (47%)	71 (51%)	0.337	316 (53%)	66 (53%)	0.967
Statin	84 (2%)	4 (3%)	0.371	23 (4%)	2 (2%)	0.214
Nitrate	313 (7%)	19 (14%)	0.002	73 (12%)	15 (12%)	0.963
Warfarin	47 (1%)	13 (9%)	<0.001	16 (3%)	3 (2%)	0.867
Loop diuretics	191 (4%)	13 (9%)	0.003	35 (6%)	6 (5%)	0.651
Thiazide diuretics	520 (11%)	14 (10%)	0.637	54 (9%)	14 (11%)	0.440
Potassium supplements	262 (6%)	12 (9%)	0.149	34 (6%)	8 (7%)	0.747
NSAIDs	570 (12%)	13 (9%)	0.274	68 (11%)	13 (11%)	0.767
Laboratory values
Serum creatinine, mg/dL	0.94 (±0.31)	1.01 (±0.63)	0.013	0.97 (±0.37)	0.97 (±0.37)	0.931
Serum potassium, mEq/L	4.19 (±0.37)	4.16 (±0.36)	0.461	4.17 (±0.38)	4.17 (±0.36)	0.974
Serum glucose, mg/dL	110 (±34)	106 (±29)	0.191	106 (±25)	102 (±18)	0.164
Uric acid, mg/dL	5.6 (±1.5)	5.6 (±1.5)	0.640	5.7 (±1.5)	5.5 (±1.5)	0.312
Total cholesterol, mg/dL	212 (±39)	211 (±40)	0.639	212 (±42)	210 (±40)	0.744
Albumin, g/dL	4.0 (±0.3)	4.0 (±0.3)	0.549	4 (±0.3)	4 (±0.3)	0.889
Interleukin-6, units/mL	2.18 (±1.82)	1.99 (±1.38)	0.219	2.12 (±1.87)	1.87 (±1.16)	0.147
C-reactive protein, mg/dL	4.4 (±7.7)	5.2 (±13.8)	0.221	4.6 (±9.2)	3.7 (±4.4)	0.264
Serum insulin, μIU/mL	17 (±23)	15 (±12)	0.388	16 (±19)	14 (±12)	0.426
Electrocardiographic findings
Bundle branch block	354 (8%)	16 (11%)	0.103	63 (11%)	14 (11%)	0.813
LV hypertrophy	159 (3%)	14 (10%)	<0.001	41 (7%)	10 (8%)	0.640
Atrial fibrillation	92 (2%)	13 (9%)	<0.001	38 (6%)	7 (6%)	0.760
Echocardiographic findings
LV systolic dysfunction	349 (8%)	11 (8%)	0.899	55 (9%)	10 (8%)	0.681

ACE = angiotensin-converting enzyme; LV = left ventricular; NSAID = non-steroidal anti-inflammatory drug.

Figure 2. Kaplan-Meier plots for incident heart failure by rheumatic heart disease (RHD). (CI = confidence interval; HR = hazard ratio).

Figure 3. Association of rheumatic heart disease (RHD) with incident heart failure (HF) in subgroups of propensity score-matched partici pants in the Cardiovascular Health Study. (CI = confidence interval; HR = hazard ratio).

Table II. Association of rheumatic heart disease (RHD) with incident heart failure.

	Events (%)
Outcomes	No-RHD	RHD	Absolute risk increase^a	Hazard ratio (95% confidence intervals)	P value
Before matching (n = 4751)	n = 4611	n = 140
Unadjusted	923 (20%)	51 (36%)	+ 16%	2.04 (1.54–2.71)	<0.001
Multivariable-adjusted^b	–	–		1.32 (1.02–1.70)	0.034
Propensity-adjusted	–	–		1.55 (1.14–2.11)	0.005
After matching (n = 720)	n = 596	n = 124
Incident heart failure	133 (22%)	41 (33%)	+ 11%	1.60 (1.13–2.28)	0.008

^aAbsolute risk increase was calculated by subtracting the percentage of events in the RHD group from the No-RHD group (before values were rounded).

^bModel adjusted for all covariates displayed in Figure 1.

Table III. Association of rheumatic heart disease (RHD) with other outcomes in the matched cohort.

	Events (%)
Outcomes	No-RHD	RHD	Absolute risk increase^a	Hazard ratio (95% confidence interval)	P value
All-cause mortality	257 (43%)	58 (47%)	+4%	1.09 (0.82–1.45)	0.568
Acute myocardial infarction	62 (10%)	18 (15%)	+5%	1.44 (0.85–2.43)	0.173
Angina pectoris	96 (16%)	26 (21%)	+5%	1.39 (0.90–2.14)	0.138
Stroke	86 (14%)	17 (14%)	0%	0.95 (0.57–1.60)	0.848
Transient ischemic attack	28 (5%)	10 (8%)	+3%	1.76 (0.85–3.62)	0.126
Peripheral arterial disease	27 (5%)	4 (3%)	−2%	0.70 (0.25–2.01)	0.510

^aAbsolute risk increase was calculated by subtracting the percentage of events in the RHD group from the No-RHD group (before values were rounded).