American Journal of Epidemiology Advance Access originally published online on May 17, 2006
American Journal of Epidemiology 2006 164(2):184-193; doi:10.1093/aje/kwj168
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Practice of Epidemiology |
Prognostic Value of a Novel Classification Scheme for Heart Failure: The Minnesota Heart Failure Criteria
1 Medical Statistics Unit, London School of Hygiene and Tropical Medicine, University of London, London, United Kingdom
2 Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN
3 Department of Nutrition, Faculty of Medicine, University of Oslo, Oslo, Norway
4 Berman Center for Outcomes and Clinical Research, Minneapolis, MN
5 Office of the Provost, University of South Carolina, Columbia, SC
Correspondence to Dr. Joseph Kim, Medical Statistics Unit, Department of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, Keppel Street, London WC1E 7HT, United Kingdom (e-mail: joseph.kim{at}lshtm.ac.uk).
The authors present the Minnesota Heart Failure Criteria (MHFC), derived using latent class analysis from widely available items in the Framingham Criteria. The authors used 1995 and 2000 data on hospitalized Minnesota Heart Survey subjects discharged after myocardial infarction or heart failure (N = 7,379). Selected Framingham Criteria variables (dyspnea, pulmonary rales, cardiomegaly, interstitial or pulmonary edema on chest radiograph, S3 heart sound, tachycardia) plus left ventricular ejection fraction were used. The discriminatory power of the MHFC was evaluated using age- and sex-adjusted 2-year mortality. A five-class latent class analysis model was collapsed into cases and noncases. Mortality estimates discriminated noncases (18%) from cases (43%) (p < 0.001). The MHFC performed better than previous truncated criteria (Framingham Criteria: 26% noncases, 43% cases; Duke Criteria: 29%, 40%; Killip Score: 31%, 44%; Boston Score: 28%, 45%). In a subset of patients admitted for heart failure (n = 5,128), the MHFC identified all but 2% (116/4,746) of cases found with a nearly full version of the Framingham Criteria. In terms of prognostic value, the MHFC are as precise as or more precise than several previous sets of truncated criteria. They closely approximate a nearly full version of the Framingham Criteria but require many fewer variables and can facilitate epidemiologic case-finding for heart failure.
cardiovascular diseases; classification; diagnosis; heart diseases; heart failure, congestive; validation studies [publication type]
Abbreviations: ICD-9, International Classification of Diseases, Ninth Revision; LCA, latent class analysis; LVEF, left ventricular ejection fraction; MHSAMI, Minnesota Heart Survey Acute Myocardial Infarction; MHSCHF, Minnesota Heart Survey Community Surveillance of Heart Failure
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