Relation Between Ventricular Premature Complexes and Incident Heart Failure

Vratika Agarwal, Eric Vittinghoff, Isaac R. Whitman, Thomas Dewland, Jonathan W. Dukes, Gregory M. Marcus

Research output: Contribution to journalArticle

6 Citations (Scopus)

Abstract

Ventricular premature complexes (VPCs) may represent a reversible cause of heart failure (HF); however, the type of patients most prone remains unknown. This study leverages a large population-based database to examine interactions that might prove clinically useful in risk-stratifying patients with VPCs. We used the California Healthcare Cost and Utilization Project to identify patients with VPCs and incident systolic HF from January 1, 2005, to December 31, 2009. We calculated hazard ratios for predictors of incident systolic HF using multivariable Cox proportional hazard models. Interactions with known risk factors were studied. Of the 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a VPC diagnosis and 198,818 (1.2%) developed systolic HF. Incidence of systolic HF was 62.8 per 1,000 patient-years (95% confidence interval [CI] 61.2 to 64.4) in those with and 6.1 per 1,000 patient-years (95% CI 6.1 to 6.2) in those without VPCs (p <0.001). After adjusting for potential confounders, VPCs were associated with a nearly twofold risk of systolic HF (HR 1.8, 95% CI 1.8 to 1.9, p <0.001). Interaction analyses revealed a stronger relation between VPCs and HF among those with fewer cardiovascular risk factors. A VPC diagnosis in younger patients (<65 years) without coronary artery disease, hypertension, diabetes, or atrial fibrillation exhibited a sixfold increased risk of systolic HF (HR 6.5, 95% CI 5.5 to 7.7, p <0.001). In conclusion, these results suggest that a diagnosis of VPCs independently predicts incident systolic HF. This effect is most pronounced in younger patients without co-morbidities, suggesting that VPCs may be an important cause of "idiopathic" HF.

Original languageEnglish (US)
JournalAmerican Journal of Cardiology
DOIs
StateAccepted/In press - Oct 27 2016

Fingerprint

Ventricular Premature Complexes
Systolic Heart Failure
Heart Failure
Confidence Intervals
Proportional Hazards Models
Health Care Costs
Atrial Fibrillation
Coronary Artery Disease
Hospitalization
Databases
Hypertension
Morbidity

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Relation Between Ventricular Premature Complexes and Incident Heart Failure. / Agarwal, Vratika; Vittinghoff, Eric; Whitman, Isaac R.; Dewland, Thomas; Dukes, Jonathan W.; Marcus, Gregory M.

In: American Journal of Cardiology, 27.10.2016.

Research output: Contribution to journalArticle

Agarwal, Vratika ; Vittinghoff, Eric ; Whitman, Isaac R. ; Dewland, Thomas ; Dukes, Jonathan W. ; Marcus, Gregory M. / Relation Between Ventricular Premature Complexes and Incident Heart Failure. In: American Journal of Cardiology. 2016.
@article{4671cde1bf984527bcb3c50735c89731,
title = "Relation Between Ventricular Premature Complexes and Incident Heart Failure",
abstract = "Ventricular premature complexes (VPCs) may represent a reversible cause of heart failure (HF); however, the type of patients most prone remains unknown. This study leverages a large population-based database to examine interactions that might prove clinically useful in risk-stratifying patients with VPCs. We used the California Healthcare Cost and Utilization Project to identify patients with VPCs and incident systolic HF from January 1, 2005, to December 31, 2009. We calculated hazard ratios for predictors of incident systolic HF using multivariable Cox proportional hazard models. Interactions with known risk factors were studied. Of the 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2{\%}) had a VPC diagnosis and 198,818 (1.2{\%}) developed systolic HF. Incidence of systolic HF was 62.8 per 1,000 patient-years (95{\%} confidence interval [CI] 61.2 to 64.4) in those with and 6.1 per 1,000 patient-years (95{\%} CI 6.1 to 6.2) in those without VPCs (p <0.001). After adjusting for potential confounders, VPCs were associated with a nearly twofold risk of systolic HF (HR 1.8, 95{\%} CI 1.8 to 1.9, p <0.001). Interaction analyses revealed a stronger relation between VPCs and HF among those with fewer cardiovascular risk factors. A VPC diagnosis in younger patients (<65 years) without coronary artery disease, hypertension, diabetes, or atrial fibrillation exhibited a sixfold increased risk of systolic HF (HR 6.5, 95{\%} CI 5.5 to 7.7, p <0.001). In conclusion, these results suggest that a diagnosis of VPCs independently predicts incident systolic HF. This effect is most pronounced in younger patients without co-morbidities, suggesting that VPCs may be an important cause of {"}idiopathic{"} HF.",
author = "Vratika Agarwal and Eric Vittinghoff and Whitman, {Isaac R.} and Thomas Dewland and Dukes, {Jonathan W.} and Marcus, {Gregory M.}",
year = "2016",
month = "10",
day = "27",
doi = "10.1016/j.amjcard.2016.12.029",
language = "English (US)",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Relation Between Ventricular Premature Complexes and Incident Heart Failure

AU - Agarwal, Vratika

AU - Vittinghoff, Eric

AU - Whitman, Isaac R.

AU - Dewland, Thomas

AU - Dukes, Jonathan W.

AU - Marcus, Gregory M.

PY - 2016/10/27

Y1 - 2016/10/27

N2 - Ventricular premature complexes (VPCs) may represent a reversible cause of heart failure (HF); however, the type of patients most prone remains unknown. This study leverages a large population-based database to examine interactions that might prove clinically useful in risk-stratifying patients with VPCs. We used the California Healthcare Cost and Utilization Project to identify patients with VPCs and incident systolic HF from January 1, 2005, to December 31, 2009. We calculated hazard ratios for predictors of incident systolic HF using multivariable Cox proportional hazard models. Interactions with known risk factors were studied. Of the 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a VPC diagnosis and 198,818 (1.2%) developed systolic HF. Incidence of systolic HF was 62.8 per 1,000 patient-years (95% confidence interval [CI] 61.2 to 64.4) in those with and 6.1 per 1,000 patient-years (95% CI 6.1 to 6.2) in those without VPCs (p <0.001). After adjusting for potential confounders, VPCs were associated with a nearly twofold risk of systolic HF (HR 1.8, 95% CI 1.8 to 1.9, p <0.001). Interaction analyses revealed a stronger relation between VPCs and HF among those with fewer cardiovascular risk factors. A VPC diagnosis in younger patients (<65 years) without coronary artery disease, hypertension, diabetes, or atrial fibrillation exhibited a sixfold increased risk of systolic HF (HR 6.5, 95% CI 5.5 to 7.7, p <0.001). In conclusion, these results suggest that a diagnosis of VPCs independently predicts incident systolic HF. This effect is most pronounced in younger patients without co-morbidities, suggesting that VPCs may be an important cause of "idiopathic" HF.

AB - Ventricular premature complexes (VPCs) may represent a reversible cause of heart failure (HF); however, the type of patients most prone remains unknown. This study leverages a large population-based database to examine interactions that might prove clinically useful in risk-stratifying patients with VPCs. We used the California Healthcare Cost and Utilization Project to identify patients with VPCs and incident systolic HF from January 1, 2005, to December 31, 2009. We calculated hazard ratios for predictors of incident systolic HF using multivariable Cox proportional hazard models. Interactions with known risk factors were studied. Of the 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a VPC diagnosis and 198,818 (1.2%) developed systolic HF. Incidence of systolic HF was 62.8 per 1,000 patient-years (95% confidence interval [CI] 61.2 to 64.4) in those with and 6.1 per 1,000 patient-years (95% CI 6.1 to 6.2) in those without VPCs (p <0.001). After adjusting for potential confounders, VPCs were associated with a nearly twofold risk of systolic HF (HR 1.8, 95% CI 1.8 to 1.9, p <0.001). Interaction analyses revealed a stronger relation between VPCs and HF among those with fewer cardiovascular risk factors. A VPC diagnosis in younger patients (<65 years) without coronary artery disease, hypertension, diabetes, or atrial fibrillation exhibited a sixfold increased risk of systolic HF (HR 6.5, 95% CI 5.5 to 7.7, p <0.001). In conclusion, these results suggest that a diagnosis of VPCs independently predicts incident systolic HF. This effect is most pronounced in younger patients without co-morbidities, suggesting that VPCs may be an important cause of "idiopathic" HF.

UR - http://www.scopus.com/inward/record.url?scp=85012289425&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85012289425&partnerID=8YFLogxK

U2 - 10.1016/j.amjcard.2016.12.029

DO - 10.1016/j.amjcard.2016.12.029

M3 - Article

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

ER -