The diagnosis of heart failure in the community. Comparative validation of four sets of criteria in unselected older adults: the ICARe Dicomano Study.

OBJECTIVES

We sought to compare construct and predictive validity of four sets of heart failure (HF) diagnostic criteria in an epidemiologic setting.

BACKGROUND

The prevalence estimates of HF vary broadly depending on the diagnostic criteria.

METHODS

Data were collected in a survey of community dwellers who were > or =65 years of age living in Dicomano, Italy. At baseline, HF was diagnosed with the criteria of the Framingham, Boston, and Gothenburg studies and of the European Society of Cardiology (ESC). Left ventricular mass index and ejection fraction, left atrium systolic dimension, lower extremity mobility disability, summary physical performance score, and 6-min walk test were compared between HF and non-HF participants to test for construct validity of each set of criteria. Predictive validity was evaluated with follow-up assessment of cardiovascular mortality, incident disability, and HF-related hospitalizations. Comparisons were adjusted for demographics, comorbidity, and psychoaffective status.

RESULTS

Of 553 participants, 11.9%, 10.7%, 20.8%, and 9.0% had HF, according to Framingham, Boston, Gothenburg, and ESC criteria, respectively. In terms of construct validity, Framingham and Boston criteria discriminated HF from non-HF participants better than Gothenburg and ESC criteria across the measures of cardiac function and global performance. The Boston criteria showed a superior predictive validity because they indicated a significantly greater adjusted risk of cardiovascular death (hazard ratio3.9, 95% confidence interval 1.2 to 13.2), incident disability, and hospitalizations in participants with HF.

CONCLUSIONS

The Boston criteria are preferable to Framingham, Gothenburg, and ESC criteria for the diagnosis of HF in older community dwellers because they have good construct validity and more accurately predict cardiovascular death, incident disability, and hospitalizations.