Congestive heart failure risk factors

Resident Survival Guide

Congestive Heart Failure Microchapters
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Acute Pharmacotherapy
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Chronic Pharmacotherapy in HFrEF Diuretics ACE Inhibitors Angiotensin receptor blockers Aldosterone Antagonists Beta Blockers Ca Channel Blockers Nitrates Hydralazine Positive Inotropics Anticoagulants Angiotensin Receptor-Neprilysin Inhibitor Antiarrhythmic Drugs Nutritional Supplements Hormonal Therapies Drugs to Avoid Drug Interactions Treatment of underlying causes Associated conditions
Exercise Training
Surgical Therapy: Biventricular Pacing or Cardiac Resynchronization Therapy (CRT) Implantation of Intracardiac Defibrillator Ultrafiltration Cardiac Surgery Left Ventricular Assist Devices (LVADs) Cardiac Transplantation
ACC/AHA Guideline Recommendations Initial and Serial Evaluation of the HF Patient Hospitalized Patient Patients With a Prior MI Sudden Cardiac Death Prevention Surgical/Percutaneous/Transcather Interventional Treatments of HF Patients at high risk for developing heart failure (Stage A) Patients with cardiac structural abnormalities or remodeling who have not developed heart failure symptoms (Stage B) Patients with current or prior symptoms of heart failure (Stage C) Patients with refractory end-stage heart failure (Stage D) Coordinating Care for Patients With Chronic HF Quality Metrics/Performance Measures
Implementation of Practice Guidelines
Congestive heart failure end-of-life considerations
Specific Groups: Special Populations Patients who have concomitant disorders Obstructive Sleep Apnea in the Patient with CHF NSTEMI with Heart Failure and Cardiogenic Shock
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Cafer Zorkun, M.D., Ph.D. [2]; Saleh El Dassouki, M.D. [3]; Atif Mohammad, M.D.

Overview

Several risk factors may predispose to heart failure. These risk factors can be demographic, genetic, associated with lifestyle or medications.

Risk Factors

Common risk factors associated with heart failure include:

Risk factors for heart failure	Prevention strategies
Sedentary habit	Regular physical activity
Cigarette smoking	Cigarette smoking cessation
Obesity	Physical activity and healthy diet
Excessive alcohol intake	General population: no/light alcohol intake is beneficial, avoiding alcohol in Patients with alcohol-induced CMP
Influenza	Influenza vaccination
Microbes (Trypanosoma cruzi, Streptococci)	Early diagnosis, antimicrobial therapy
Cardiotoxic drugs (anthracyclines)	Cardiac function and side effect monitoring, dose adaptation, change of chemotherapy
Chest radiation	Cardiac function and side effect monitoring, dose adaptation
Hypertension	Life style modification, antihypertensive drugs
Hyperlipidemia	Healthy diet, statins
Diabetes mellitus	Physical activities, healthy diet, SGLT2 inhibitors
Coronary artery disease	Life style modification, statins

The above table adopted from 2021 ESC Guideline

1. Demographic factors
   • Age (increased)
   • Low socioeconomic status
2. Lifestyle-related factors
   • Tobacco and coffee consumption
   • Alcohol consumption
   • Dietary sodium intake
   • Recreational drug use: Cocaine, methamphetamines.
3. Comorbidities
   • Hypertension
   • Left ventricular hypertrophy
   • Myocardial infarction
   • Obesity
   • Diabetes mellitus
   • Valvular heart disease
   • Renal insufficiency
   • Dyslipidemia
   • Sleep apnea
   • Tachycardia
   • Impaired lung function
   • Depression
4. Echocardiographic factors
   • Ventricular dimension
   • Ventricular mass
   • Diastolic filling impairment
5. Pharmacological factors
   • Chemotherapeutic agents
   • Non-steroidal anti-inflammatory drugs
   • Thiazolidinediones
   • Doxazosin
6. Biochemical
   • Albuminuria
   • Homocysteine: Elevated plasma homocysteine levels are associated with almost a 75% increase in risk for heart failure development.
   • Tumor necrosis factor-alpha (TNF-alpha): After adjustment for other risk factors, every tertile increment in tumor necrosis factor-alpha (TNF-alpha) levels was associated with a 60% increase in risk of heart failure. TNF-alpha has several negative pleiotropic effects and also negative inotropic properties that may be responsible for excessive heart failure risk. TNF-alpha is also associated with progression of heart failure.
   • Interleukin-6: IL-6 is a pro-inflammatory cytokine which associated with an excessive risk of development of heart failure.
   • C-reactive protein
   • Insulin-like growth factor-I (IGF-I)
   • Natriuretic peptides
7. Genetic risk factors
   • Genetic polymorphism

Risk Factors Associated with Heart Failure Progression and Outcomes

1. Clinical
   • Etiology
   • Age
   • Gender
   • Symptom duration
   • NYHA class
   • Weight
   • Heart rate
   • Mean arterial pressure
   • S3 gallop
   • Jugular venous pressure
   • Cardiothoracic ratio
   • Renal function
   • Serum sodium
   • Troponin T
   • History of diabetes
   • Anemia
2. Echocardiographic
   • Ejection fraction
   • Exercise ejection fraction
   • Ventricular dimensions
   • Sphericity index
   • Prolonged isovolumic relaxation
   • Restrictive mitral filling
   • Changes in E/A ratio
   • Mitral regurgitation
   • Contractile reserve
   • Left ventricular mass
3. Exercise Tolerance
   • Exercise duration
   • Peak O2 consumption
   • VE/VCO2
   • Anaerobic threshold 6-minute walk test
4. Hemodynamics
   • Cardiac index
   • Pulmonary artery pressure
   • Pulmonary artery wedge pressure
   • Pulmonary vascular resistance
   • Stroke work index
   • Right atrial pressure
   • A-V oxygen difference
   • Coronary sinus O₂ content
5. Electrophysiological
   • Conduction delay
   • Atrial arrhythmia
   • Family history of sudden death
   • Presence of late potentials
   • QT dispersion
   • T wave alternans
6. Neurohormonal
   • Renin-angiotensin system
   • Angiotensin II
   • Aldosterone
   • Plasma renin activity
   • Sympathetic nervous system

     • Norepinephrine
     • Epinephrine
     • Heart rate variability
     • Norepinephrine spillover

7. Natriuretic factors
   • Atrial natriuretic peptide (ANP)
   • B-type natriuretic peptide
   • N-terminal-pro-ANP
8. Cytokines and others
   • TNF-alpha
   • Interleukin-6
   • Endothelin
   • ICAM-1 and Neuropeptide Y (NPY)
   • Arginine vasopressin