Copyright © 2004 by the Johns Hopkins Bloomberg School of Public Health
ORIGINAL CONTRIBUTIONS |
Survival Associated with Two Sets of Diagnostic Criteria for Congestive Heart Failure
1 Department of Epidemiology, Cardiovascular Health Research Unit, University of Washington, Seattle, WA.
2 Department of Medicine, Cardiovascular Health Research Unit, University of Washington, Seattle, WA.
3 Department of Biostatistics, Cardiovascular Health Research Unit, University of Washington, Seattle, WA.
4 Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic and Mayo Foundation, Rochester, MN.
5 Section on Cardiology, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC.
6 Department of Medicine, University of Mississippi Medical Center, Jackson, MS.
7 National Heart, Lung, and Blood Institute and the Framingham Heart Study, Framingham, MA.
8 Department of Health Services, Cardiovascular Health Research Unit, University of Washington, Seattle, WA.
Congestive heart failure (CHF) definitions vary across epidemiologic studies. The Framingham Heart Study criteria include CHF signs and symptoms assessed by a physician panel. In the Cardiovascular Health Study, a committee of physicians adjudicated CHF diagnoses, confirmed by signs, symptoms, clinical tests, and/or medical therapy. The authors used data from the Cardiovascular Health Study, a population-based cohort study of 5,888 elderly US adults, to compare CHF incidence and survival patterns following onset of CHF as defined by Framingham and/or Cardiovascular Health Study criteria. They constructed an inception cohort of nonfatal, hospitalized CHF patients. Of 875 participants who had qualifying CHF hospitalizations between 1989 and 2000, 54% experienced a first CHF event that fulfilled both sets of diagnostic criteria (concordant), 31% fulfilled only the Framingham criteria (Framingham only), and 15% fulfilled only the Cardiovascular Health Study criteria (Cardiovascular Health Study only). No significant survival difference was found between the Framingham-only group (hazard ratio = 0.87, 95% confidence interval: 0.71, 1.07) or the Cardiovascular Health Study-only group (hazard ratio = 0.89, 95% confidence interval: 0.68, 1.15) and the concordant group (referent). Compared with Cardiovascular Health Study central adjudication, Framingham criteria for CHF identified a larger group of participants with incident CHF, but all-cause mortality rates were similar across these diagnostic classifications.
follow-up studies; heart failure, congestive; prognosis; survival
Abbreviations: Abbreviations: CHF, congestive heart failure; CI, confidence interval; FEV1, forced expiratory volume in 1 second; HR, hazard ratio.
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