Clep_a_253612 607..616

Moa P Lee Robert J Glynn 1 Sebastian Schneeweiss 1 Kueiyu Joshua Lin Elisabetta Patorno Julie Barberio Raisa Levin Thomas Evers 4 Shirley V Wang 1 Rishi J Desai 1 1Division of Pharmacoepidemiology and Pharmacoeconomics, Brigham and Women’s Hospital & Harvard Medical School, Boston, MA, USA; 2Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA; 3Department of Medicine, Massachusetts General Hospital & Harvard Medical School, Boston, MA, USA; 4Bayer AG, Wuppertal, Germany Background: The differential impact of various demographic characteristics and comorbid conditions on development of heart failure (HF) with preserved (pEF) and reduced ejection fraction (rEF) is not well studied among the elderly. Methods: Using Medicare claims data linked to electronic health records, we conducted an observational cohort study of individuals ≥65 years of age without HF. A Cox proportional hazards model accounting for competing risk of HFrEF and HFpEF incidence was constructed. A gradient-boosted model (GBM) assessed the relative influence (RI) of each predictor in the development of HFrEF and HFpEF. Results: Among 138,388 included individuals, 9701 developed HF (incidence rate = 20.9 per 1000 person-years). Males were more likely to develop HFrEF than HFpEF (HR = 2.07, 95% CI: 1.81–2.37 vs. 1.11, 95% CI: 1.02–1.20, P for heterogeneity <0.01). Atrial fibrillation and pulmonary hypertension had stronger associations with the risk of HFpEF (HR = 2.02, 95% CI: 1.80–2.26 and 1.66, 95% CI: 1.23–2.22) while cardiomyopathy and myocardial infarction were more strongly associated with HFrEF (HR = 4.37, 95% CI: 3.21–5.97 and 1.94, 95% CI: 1.23–3.07). Age was the strongest predictor across all HF subtypes with RI from GBM >35%. Atrial fibrillation was the most influential comorbidity for the development of HFpEF (RI = 8.4%) while cardiomyopathy was the most influential comorbidity for the development of HFrEF (RI = 20.7%). Conclusion: These findings of heterogeneous relationships between several important risk factors and heart failure types underline the potential differences in the etiology of HFpEF and HFrEF.