OBJECTIVES: Heart failure (HF) imposes a significant burden on patients, providers, and payers. This study aimed to measure the impact of risk factors on HF.

METHODS: Adult patients from the US Department of Defense (DoD) data population who were aged ≥18 years with their first diagnosis for HF (ICD-9-CM: 428.xx; ICD-10-CM: I50) were included for study (01OCT2012-30SEP2015 = identification period). For the HF cohort, the first HF diagnosis date was designated as the index date. A control cohort was generated for patients without an HF diagnosis from 01OCT2011-30SEP2016. A random index date within the identification period was selected for controls. Patients were also required to have continuous health plan enrollment for 12 months pre-index date (baseline period) and 12 months post-index date (follow-up period). Logistic regression was used to assess the odds of HF, controlling for patient demographics (age, sex, geographic region), Charlson Comorbidity Index (CCI) score, and baseline health care utilization.

RESULTS: A total of 37,781 case-control pairs were identified; mean age was 66 years for case and 44 years for control patients (p<0.001). A majority (53%) of patients were male. The average CCI score was 2.8 for cases and 0.3 for controls (p<0.001). Compared to control patients, a higher proportion of HF patients had baseline comorbidities, including diabetes (56% vs 9%) and chronic obstructive pulmonary disease (35% vs 7%). Logistic regression showed that male sex category (odds ratio [OR]=1.7, 95% CI=1.6-1.8), increased age (OR=4.6, 95% confidence interval [CI]=4.1-5.2 for ages 41-64; OR=7.7, 95% CI=6.7-8.9 for age ≥65; reference: age 18-40), baseline ER visits (OR=4.1, 95% CI=3.6-4.6), and inpatient admissions (OR=1.6, 95% CI=1.3-2.0) were positively associated with the risk of HF among other factors.

CONCLUSIONS: In the US DoD population, increased age and baseline ER visits were two primary predictors of HF.