Key result
Incident CVD accounts for ~18% of HF deaths, suggesting most stem from non-CVD causes.
Why the study?
Although AMI and stroke are clinically associated with HF, their contribution to HF as the underlying cause of death in vital statistics was unclear.
What is the contribution of incident cardiovascular disease (AMI, SCD, stroke) to heart failure as the underlying cause of death?
Cohort (n=140,420)
Yes
What is the contribution of incident cardiovascular disease (AMI, SCD, stroke) to heart failure as the underlying cause of death?
Cardiovascular diseases such as AMI and stroke account for only a small fraction (17.6%) of deaths where heart failure is listed as the underlying cause, suggesting other underlying causes are responsible for most HF deaths in vital statistics.
Most HF deaths link to non-CVD causes on records; hypothesis-generating and requires prospective validation before guiding prevention.
BACKGROUND: There is considerable interest in the trending discrepancy between ischemic heart disease (IHD) and heart failure (HF) in vital statistics. Clinically, acute myocardial infarction (AMI) and stroke are closely associated with HF, but their contribution to HF as the underlying cause of death (UCD) is unclear. METHODS AND RESULTS: In 1990 and 1992-1993, we enrolled a total of 140,420 residents of Japanese nationality (aged 40-69 years) from 11 public health center areas. We prospectively examined the occurrence of cardiovascular disease (CVD), including AMI, sudden cardiac death within 1 h (SCD), and stroke, and analyzed the 14,375 participants without a history of CVD at baseline who died during the 20-year follow-up. A time-dependent Cox proportional hazards model was used to estimate hazard ratios and the population attributable fraction (PAF) of AMI, AMI+SCD, stroke, and CVD for deaths due to HF, IHD, and cerebrovascular disease as the UCD, adjusted for individuals' lifestyles and comorbid conditions. The PAF of AMI for HF deaths was 2.4% (95% confidence interval [CI] 1.7-2.9%), which increased to 12.0% (95% CI 11.6-12.2%) for AMI+SCD. The PAF of CVD-attributed HF deaths was estimated to be 17.6% (95% CI 15.9-18.9%). CONCLUSIONS: HF as the UCD was partly explained by CVD. The data imply that most HF deaths reported in vital statistics may be associated with underlying causes other than CVD.
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Saito et al. (2023) conducted a cohort in Heart failure (n=140,420). Incident cardiovascular disease (AMI, SCD, stroke) was evaluated on Population attributable fraction (PAF) of CVD for deaths due to heart failure as the underlying cause of death (PAF 17.6%, 95% CI 15.9-18.9). Incident cardiovascular disease accounted for a population attributable fraction of 17.6% (95% CI 15.9-18.9%) for heart failure deaths, suggesting most HF deaths are associated with non-CVD causes.
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