Development and Validation of a Long-Term Incident Heart Failure Risk Model

Background: Average lifetime risk for heart failure (HF) is high but differs significantly across and within sex-race groups. No models for estimating long-term risk for HF exist, which would allow for earlier identification and interventions in high-risk subsets. The authors aim to derive 30-year HF risk equations. Methods: Adults between the ages of 20 to 59 years and free of cardiovascular disease at baseline from 5 population-based cohorts were included. Among 24 838 participants (55% women, 25% Black based on self-report), follow-up consisted of 599 551 person-years. Sex- and race-specific 30-year HF risk equations were derived and validated accounting for competing risk of non-HF death. HF was based on a clinical diagnosis. Model discrimination and calibration were assessed using 10-fold cross-validation. Finally, the model was applied to varying risk factor patterns for systematic examination. Results: The rate of incident HF was 4.0 per 1000 person-years. Harrell C statistics were 0.82 (0.80–0.83) and 0.84 (0.82–0.85) in White and Black men and 0.84 (0.82–0.85) and 0.85 (0.83–0.87) in White and Black women, respectively. Hosmer-Lemeshow calibration was acceptable, with χ 2 <30 in all subgroups. Risk estimation varied across sex-race groups: for example, in an average 40-year-old nonsmoker with an untreated systolic blood pressure of 140 mm Hg and body mass index of 30 kg/m 2 , risk was estimated to be 22.8% in a Black man, 13.7% in a White man, 13.0% in a Black woman, and 12.1% in a White woman. Conclusions: Sex- and race-specific equations for prediction of long-term risk of HF demonstrated high discrimination and adequate calibration.