Characteristics, prevalence, and outcomes of patients at high risk of developing heart failure: a nationwide cohort study
C Gansted, C S Soendergaard, L H Blicher, M B Henningsen, K Docherty, O Vardeny, M Cikes, E Kato, F Martinez, A S Bhatt, M Vaduganathan, J McMurray, S Solomon, O Vedin, T Biering-SoerensenAbstract
Background
Heart failure (HF) is characterized by high morbidity, mortality, and increased healthcare costs. The condition's poor prognosis underscores the urgent need for early intervention, and the stratification of individuals along the continuum of healthy, at risk-HF, and HF is essential for improving prevention, diagnosis, and management strategies.
Purpose
To characterize the burden of at risk-HF in the society, and to assess the risk of developing HF.
Methods
This was an observational, retrospective, nationwide, register-based cohort study of at risk-HF patients. Data was collected from linked Danish nationwide registers. Within this population different at risk-HF populations were identified with the first-time diagnosis given from 2009 to 2025. At risk-HF populations were identified as (1) patients with cardiovascular disease (CVD) including ischemic heart disease, stroke, and peripheral vascular disease; (2) patients with hypertension (HTN); (3) patients with type 2 diabetes (T2D); (4) patients with two of the conditions (CVD, HTN, and T2D); (5) patients with all three of conditions. Baseline characteristics were summarized for each group and compared by Pearson’s Chi-squared test and Kruskal-Wallis rank sum test, respectively. Additionally, we calculated the 10 year cumulative incidence of HF for each at risk-HF group with a Kaplan-Meier curve. Furthermore, we calculated the incidence of HF for each at risk-HF group per 1000 person-years.
Results
Among Denmark’s population aged 18 years and older, we identified 925,755 patients with at risk-HF (Figure 1). Of these, 385,371 had CVD only, 422,395 had HTN only, and 117,989 had T2D only. Furthermore, 419,277 had two of the conditions (CVD, HTN, and T2D), and 106,179 had all three conditions. The sex distribution differed significantly among the individual at risk-HF groups (p<0.001), and the mean ages were also significantly different (p<0.001) (Figure 1). The 10 year cumulative incidence of HF (Figure 2) was highest in the group with all three conditions (29.6% developed HF), followed by the group with two of the three conditions (18.9% developed HF). Among patients with only one condition, HF incidence was highest in the CVD only group (13.0%), followed by the HTN only group (7.3%) and the T2D only group (5.9%). The incidence of HF over time increased by number of conditions. Among patients with only one condition, the incidence was 14.6 per 1000 patient-years (14.5; 14.7). In the group with two of the three conditions, the incidence was 20.3 per 1000 patient-years (20.3; 20.6). For patients with all three conditions, the incidence was 31.2 per 1000 patient-years (31.0; 31.9).
Conclusion
CVD, HTN, and T2D were independently associated with the development of HF, and the risk of HF increased with the number of risk factors present.Figure 2