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William B. Kannel, MD, MPH; Ralph B. D'Agostino, PhD; Halit Silbershatz, PhD; Albert J. Belanger, MS; Peter W. F. Wilson, MD; Daniel Levy, MD

Arch Intern Med. 1999;159:1197-1204.

Context  We devised a risk appraisal function to assess the hazard of heart failure in persons who are predisposed by coronary disease, hypertension, or valvular heart disease.

Objective  To provide general practitioners and internists with a cost-effective method to select people at high risk who are likely to have impaired left ventricular systolic function and may therefore require further evaluation and aggressive preventive measures.

Methods  The routinely measured risk factors used in constructing the heart failure profile include age, electrocardiographic left ventricular hypertrophy, cardiomegaly on chest x-ray film, heart rate, systolic blood pressure, vital capacity, diabetes mellitus, evidence of myocardial infarction, and valvular disease or hypertension. Based on 486 heart failure cases during 38 years of follow-up, 4-year probabilities of failure were computed using the pooled logistic regression model for each sex; a simple point score system was employed. A multivariate profile was also produced without the vital capacity or chest x-ray film because these may not be readily available in some clinical settings.

Results  Using the risk factors that make up the multivariate risk formulation—derived from ordinary office procedures—the probability of developing heart failure can be estimated and compared with the average risk for persons of the same age and sex. Using this risk profile, 60% of events in men and 73% in women occurred in subjects in the top quintile of multivariate risk.

Conclusions  Using this multivariate risk formulation, it is possible to identify high-risk candidates for heart failure who are likely to have a substantial yield of positive findings when tested for objective evidence of presymptomatic left ventricular dysfunction. The risk profile may also identify candidates who are at high risk for heart failure because of multiple, marginal risk factor abnormalities that might otherwise be overlooked.

From the Department of Preventive Medicine and Epidemiology, Evans Department of Clinical Research, Boston University School of Medicine, Boston, Mass (Drs Kannel, D'Agostino, Silbershatz, Wilson, and Levy and Mr Belanger); and the National Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, Md (Drs Wilson and Levy). These authors are affiliated with the Framingham Heart Study; see the acknowledgments at the end of this article for further information.

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