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Eur J Heart Fail. 2019 Oct;21(10):1197-1206. doi: 10.1002/ejhf.1350. Epub 2019 Jan 7.

Risk factors for incident heart failure in age- and sex-specific strata: a population-based cohort using linked electronic health records.

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Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
Farr Institute of Health Informatics Research, Institute of Health Informatics, University College London, London, UK.
Department of Cardiology, Division Heart & Lungs, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
The National Institute for Health Research, Biomedical Research Centre, University College London Hospitals NHS Foundation Trust, London, UK.
Institute of Cardiovascular Science, Faculty of Population Health Sciences, University College London, London, UK.



Several risk factors for incident heart failure (HF) have been previously identified, however large electronic health records (EHR) datasets may provide the opportunity to examine the consistency of risk factors across different subgroups from the general population.


We used linked EHR data from 2000 to 2010 as part of the UK-based CALIBER resource to select a cohort of 871 687 individuals 55 years or older and free of HF at baseline. The primary endpoint was the first record of HF from primary or secondary care. Cox proportional hazards analysis was used to estimate hazard ratios for associations between risk factors and incident HF, separately for men and women and by age category: 55-64, 65-74, and > 75 years. During 5.8 years of median follow-up, a total of 47 987 incident HF cases were recorded. Age, social deprivation, smoking, sedentary lifestyle, diabetes, atrial fibrillation, chronic obstructive pulmonary disease, body mass index, haemoglobin, total white blood cell count and creatinine were associated with HF. Smoking, atrial fibrillation and diabetes showed stronger associations with incident HF in women compared to men.


We confirmed associations of several risk factors with HF in this large population-based cohort across age and sex subgroups. Mainly modifiable risk factors and comorbidities are strongly associated with incident HF, highlighting the importance of preventive strategies targeting such risk factors for HF.


Electronic health records; Heart failure; Incidence; Population attributable risk; Risk factors


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