Epidemiology and risk profile of cardiac failure
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A three-decade examination of the prevalence, incidence, secular trends, and prognosis of cardiac failure in the Framingham Study provides insights into its epidemiology. Annual incidence of CHF is observed to increase from 3 to 1000 at ages 35–64, to 10 per 1000 at ages 65–94. There is a slight male predominance, owing to a higher rate of coronary disease, which conferred a fourfold risk of cardiac failure. Most cardiac failure is on the basis of long-standing hypertension or CHD. Silent infarctions were as predisposing for CHF as symptomatic MIs surviving 1 year.
Hypertension is a major predisposing factor that at least triples the CHF risk, the systolic component being more predictive than the diastolic component.
Correctable predisposing risk factors for CHF include: elevated blood pressure, impaired glucose tolerance, elevated cholesterol, low HDL-cholesterol, obesity, and a high hematocrit. Risk factors reflecting deteriorating cardiac function also were highly predictive, including: an enlarged heart, poor vital capacity, sinus tachycardia, and ECG-LVH. Commonly encountered ECG abnormalities such as intraventricular block, nonspecific repolarization abnormality, and ECG-LVH are all associated with a substantial risk of CHF. ECG-LVH carries a higher risk than x-ray enlargement.
Sudden death was a common feature with CHF, occurring at 5 times the general population rate, even excluding those with overt CHD. Using the standard cardiovascular risk factors (age, systolic blood pressure, cholesterol, glucose, eigarettes, and ECG-LVH) jointly, it is possible to identify one tenth of the population from which 40% of CHF events evolve, in the absence of interim CHD or RHD.
- McKeePA, CastelliWP, McNamaraPM, et al. The natural history of congestive heart failure: The Framingham Study.N Engl J Med 1971;285:1441–1446.
- KannelWB, HjortlandM, CastelliWP. Role of diabetes in congestive heart failure: The Framingham Study.Am J Cardiol 1974;34:29–34.
- KannelWB, CastelliWP, McNamaraPM, et al. Role of blood pressure in the development of congestive cardiac failure.N Engl J Med 1982;287:781–787.
- KannelWB, AbbottRD. A prognostic comparison of asymptomatic left ventricular hypertrophy and unrecognized myocardial infarction.Am Heart J 1986;111:383–390.
- Veterans Administration Cooperative Study Group on Antihypertensive Agents. Effects of treatment on morbidity in hypertension. II. Results in patients with diastolic blood pressure, averaging 90–114 mmHg.JAMA 1970;263:1143–1152.
- KannelWB, GordonT, CastelliWP, MargolisJR. ECG-left ventricular hypertrophy and risk of CHD: The Framingham Study.Ann Intern Med 1970;72:813–822.
- KlainerLM, GibsonTC, WhiteKL. The epidemiology of cardiac failure.J Chronic Dis 1965;18:797–814.
- MassieB, PortsT, ChatterjeeK, et al. Long-term vasodilator therapy for heart failure: Clinical response and its relationship to hemodynamic measurements.Circulation 1981; 63:269–278.
- FranciosaJA, WilenM, ZiescheS, et al. Survival in men with severe chronic left ventricular failure due to either coronary heart disease or idiopathic dilated cardiomyopathy.Am J Cardiol 1983;51:831–836.
- SpainDM, BradessWV, MohrC. Coronary atherosclerosis as a cause of unexpected and unexplained death: An autopsy study from 1949–1959.JAMA 1960;174:384–388.
- ChiangBN, PerlmanLV, FultonM, et al. Predisposing factors in sudden cardiac death in Tecumseh, Michigan: A prospective study.Circulation 1970;41:31–37.
- KannelWB, DoyleJT, McNamaraPM, et al. Precursors of sudden coronary death: Factors related to the incidence of sudden death.Circulation 1975;51:606–613.
- BurggrafGW, ParkerJO. Prognosis in coronary artery disease, angiographic, hemodynamic and clinical factors.Circulation 1975;51:146–156.
- MukharjiJ, RudeRE, PooleK, et al. Risk factors for sudden death after acute myocardial infarction: Two-year follow-up.Am J Cardiol 1984;54:31–36.
- CaliffRM, McKinnisRA, BurksJ, et al. Prognostic implication of ventricular arrhythmias during 24 hour ambulatory monitoring in patients undergoing cardiac catheterization for coronary artery disease.Am J Cardiol 1982;50:23–31.
- RubermanW, WeinblattE, GoldbergJ, et al. Ventricular premature complexes and sudden death after myocardial infarction.Circulation 1981;64:297–305.
- VonOlshausenK, SchaferA, MehmeHC, et al. Ventricular arrhythmias in idiopathic dilated cardiomyopathy.Br Heart J 1984;51:195–201.
- HambyRI. Primary myocardial disease: A prognostic clinical and hemodynamic evaluation in 100 patients.Medicine 1970;49:55–78.
- FusterV, GershBJ, GiulianiER, et al. The natural history of idiopathic dilated cardiomyopathy.Am J Cardiol 1981; 47:525–531.
- SouferR, WohlgelernterD, VitaNA, et al. Intact systolic left ventricular function in clinical congestive heart failure.Am J Cardiol 1985;55:1032–1036.
- CohnJN, ArchibaldDG, ZiescheS, et al. Effect of vasodilator therapy on mortality in chronic congestive failure: Results of a Veterans Administration Cooperative Study.N Engl J Med 1986;314:1547–1552.
- FurbergCD, YusufS. Effects of vasodilators on survival in chronic congestive heart failure.Am J Cardiol 1985;55:1110–1113.
- FrancisGS, GoldsmithSR, LevinsTB, et al. The neurohumoral axis in congestive heart failure.Ann Intern Med 1984;101:370–377.
- BertusJR, FlakerGC, RuderMA, et al. Do patients with cardiac arrest and hypokalemia require antiarrhythmic drug therapy (abstract)?Circulation 1984;70:II-443.
- LevyD, AndersonKM, ChristiansenJ, et al. Prevalence of ventricular arrhythmias in hypertensives treated with β-blockers or diuretics: The Framingham Study (abstract).Circulation 1986;74:II-489.
- Helfant RH. Hypokalemia and arrhythmias.Am J Med 1986;Suppl 4A:13–22.
- KannelWB, McGeeDL, GordonT. A general cardiovascular risk profile: The Framingham Study.Am J Cardiol 1976; 38:46–57.
- Epidemiology and risk profile of cardiac failure
Cardiovascular Drugs and Therapy
Volume 2, Issue 1 Supplement, pp 387-395
- Cover Date
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- Online ISSN
- Kluwer Academic Publishers
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- cardiac failure
- risk factors
- sudden death
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- Author Affiliations
- 1. Section of Preventative Medicine and Epidemiology, Boston University School of Medicine, Doctor's Office Building 720 Harrison Avenue, Suite 1105, 02118, Boston, MA, USA
- 2. Boston University School of Public Health, 80 East Concord Street, 02118, Boston, MA, USA