Abstract and Introduction
Abstract
Aims Although studies of the accuracy of heart failure (HF) classification scoring systems are available, few have examined their performance when restricted to self-reported items.
Methods and results We evaluated the association between a simplified version of the Gothenburg score, a validated HF score comprised of cardiac and pulmonary signs and symptoms and medication use, and incident HF hospitalizations in 15 430 Atherosclerosis Risk in Communities (ARIC) Study participants. Gothenburg scores (range: 0–3) were constructed using self-reported items obtained at study baseline (1987–89). Incident HF hospitalization over 14.7 years of follow-up was defined as the first identified hospitalization with an ICD-9 discharge code of 428 (n = 1668). Self-reported Gothenburg scores demonstrated very high agreement with the original metric comprised of self-reported and clinical measures and were directly associated with incident HF hospitalizations: [score = 1: hazard rate ratio (HRR) = 1.23 (1.07–1.42); score = 2: HRR = 2.17 (1.92–2.43); score = 3: HRR = 3.98 (3.37–4.70)].
Conclusion In a population-based cohort, self-reported Gothenburg criteria items were associated with hospitalized HF over a prolonged follow-up time. The association was also consistent across groups defined by sex and race, suggesting that this simple score deserves further study as a screening tool for the identification of individuals at high risk of HF in resource-limited settings.
Introduction
Heart failure (HF) is a common, costly, disabling, and often fatal disorder that affects approximately 14 million Europeans and 5.7 million Americans. Although treatment can reduce considerable morbidity and mortality attributed to HF, approximately half of those with HF die within 5 years after diagnosis. The changing demography of the world's population, including recent estimates suggesting that 2 billion persons will be aged 60 or greater in 2050, further underscore the worldwide public health burden posed by HF.
The need for accurate and standardized HF classification criteria operable for therapeutic trials and epidemiologic studies prompted the development of several HF scoring systems including Framingham, Gothenburg, NHANES-I, and Boston. All scores share the same basic format of incorporating HF signs, symptoms, and clinical indices (to which various weights may be applied), although the presence of rales is the only criterion included in all scores. Three of the questionnaires, Framingham, Gothenburg, and NHANES-I, were designed for epidemiologic studies; the others were developed for drug trials.
Although studies have contrasted the accuracy of HF scoring systems for HF classification, few have examined the performance of parsimonious scoring systems restricted to items obtained through self report. In particular, criteria that are simple to administer may facilitate screening of those at risk of future HF hospitalization, a salient question since HF consumes 1–2% of healthcare resources in developed countries. Thus, we evaluated the association between Gothenburg scores based on self-reported items and incident HF hospitalizations in the cohort of the Atherosclerosis Risk in Communities (ARIC) Study.