Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries
Background Nonalcoholic fatty liver disease (NAFLD) and heart failure (HF) are increasing in prevalence. The independent association between NAFLD and downstream risk of HF and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection fraction) is not well established. Methods an...
| Main Authors: | , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2021-11-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| Subjects: | |
| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.121.021654 |
| _version_ | 1811310949179588608 |
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| author | Marat Fudim Lin Zhong Kershaw V. Patel Rohan Khera Manal F. Abdelmalek Anna Mae Diehl Robert W. McGarrah Jeroen Molinger Cynthia A. Moylan Vishal N. Rao Kara Wegermann Ian J. Neeland Ethan A. Halm Sandeep R. Das Ambarish Pandey |
| author_facet | Marat Fudim Lin Zhong Kershaw V. Patel Rohan Khera Manal F. Abdelmalek Anna Mae Diehl Robert W. McGarrah Jeroen Molinger Cynthia A. Moylan Vishal N. Rao Kara Wegermann Ian J. Neeland Ethan A. Halm Sandeep R. Das Ambarish Pandey |
| author_sort | Marat Fudim |
| collection | DOAJ |
| description | Background Nonalcoholic fatty liver disease (NAFLD) and heart failure (HF) are increasing in prevalence. The independent association between NAFLD and downstream risk of HF and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection fraction) is not well established. Methods and Results This was a retrospective, cohort study among Medicare beneficiaries. We selected Medicare beneficiaries without known prior diagnosis of HF. NAFLD was defined using presence of 1 inpatient or 2 outpatient claims using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM), claims codes. Incident HF was defined using at least 1 inpatient or at least 2 outpatient HF claims during the follow‐up period (October 2015–December 2016). Among 870 535 Medicare patients, 3.2% (N=27 919) had a clinical diagnosis of NAFLD. Patients with NAFLD were more commonly women, were less commonly Black patients, and had a higher burden of comorbidities, such as diabetes, obesity, and kidney disease. Over a mean 14.3 months of follow‐up, patients with (versus without) baseline NAFLD had a significantly higher risk of new‐onset HF in unadjusted (6.4% versus 5.0%; P<0.001) and adjusted (adjusted hazard ratio [HR] [95% CI], 1.23 [1.18–1.29]) analyses. Among HF subtypes, the association of NAFLD with downstream risk of HF was stronger for HF with preserved ejection fraction (adjusted HR [95% CI], 1.24 [1.14–1.34]) compared with HF with reduced ejection fraction (adjusted HR [95% CI], 1.09 [0.98–1.2]). Conclusions Patients with NAFLD are at an increased risk of incident HF, with a higher risk of developing HF with preserved ejection fraction versus HF with reduced ejection fraction. The persistence of an increased risk after adjustment for clinical and demographic factors suggests an epidemiological link between NAFLD and HF beyond the basis of shared risk factors that requires further investigation. |
| first_indexed | 2024-04-13T10:09:14Z |
| format | Article |
| id | doaj.art-0348b254322045d6b98f37ff6e5d05af |
| institution | Directory Open Access Journal |
| issn | 2047-9980 |
| language | English |
| last_indexed | 2024-04-13T10:09:14Z |
| publishDate | 2021-11-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj.art-0348b254322045d6b98f37ff6e5d05af2022-12-22T02:50:58ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802021-11-01102210.1161/JAHA.121.021654Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare BeneficiariesMarat Fudim0Lin Zhong1Kershaw V. Patel2Rohan Khera3Manal F. Abdelmalek4Anna Mae Diehl5Robert W. McGarrah6Jeroen Molinger7Cynthia A. Moylan8Vishal N. Rao9Kara Wegermann10Ian J. Neeland11Ethan A. Halm12Sandeep R. Das13Ambarish Pandey14Division of Cardiology Duke University Medical Center Durham NCDivision of Cardiology University of Texas Southwestern Medical Center Dallas TXDepartment of Cardiology Houston Methodist DeBakey Heart and Vascular Center Houston TXDivision of Cardiology Yale Medical Center New Haven CTDivision of Gastroenterology Duke University Medical Center Durham NCDivision of Gastroenterology Duke University Medical Center Durham NCDivision of Cardiology Duke University Medical Center Durham NCDivision of Cardiology Duke University Medical Center Durham NCDivision of Gastroenterology Duke University Medical Center Durham NCDivision of Cardiology Duke University Medical Center Durham NCDivision of Gastroenterology Duke University Medical Center Durham NCHarrington Heart and Vascular Institute University Hospitals Cleveland Medical CenterCase Western Reserve University School of Medicine Cleveland OHDivision of Cardiology University of Texas Southwestern Medical Center Dallas TXDepartment of Internal Medicine Cardiology Division University of Texas Southwestern Medical Center Dallas TXDepartment of Internal Medicine Cardiology Division University of Texas Southwestern Medical Center Dallas TXBackground Nonalcoholic fatty liver disease (NAFLD) and heart failure (HF) are increasing in prevalence. The independent association between NAFLD and downstream risk of HF and HF subtypes (HF with preserved ejection fraction and HF with reduced ejection fraction) is not well established. Methods and Results This was a retrospective, cohort study among Medicare beneficiaries. We selected Medicare beneficiaries without known prior diagnosis of HF. NAFLD was defined using presence of 1 inpatient or 2 outpatient claims using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD‐9‐CM), claims codes. Incident HF was defined using at least 1 inpatient or at least 2 outpatient HF claims during the follow‐up period (October 2015–December 2016). Among 870 535 Medicare patients, 3.2% (N=27 919) had a clinical diagnosis of NAFLD. Patients with NAFLD were more commonly women, were less commonly Black patients, and had a higher burden of comorbidities, such as diabetes, obesity, and kidney disease. Over a mean 14.3 months of follow‐up, patients with (versus without) baseline NAFLD had a significantly higher risk of new‐onset HF in unadjusted (6.4% versus 5.0%; P<0.001) and adjusted (adjusted hazard ratio [HR] [95% CI], 1.23 [1.18–1.29]) analyses. Among HF subtypes, the association of NAFLD with downstream risk of HF was stronger for HF with preserved ejection fraction (adjusted HR [95% CI], 1.24 [1.14–1.34]) compared with HF with reduced ejection fraction (adjusted HR [95% CI], 1.09 [0.98–1.2]). Conclusions Patients with NAFLD are at an increased risk of incident HF, with a higher risk of developing HF with preserved ejection fraction versus HF with reduced ejection fraction. The persistence of an increased risk after adjustment for clinical and demographic factors suggests an epidemiological link between NAFLD and HF beyond the basis of shared risk factors that requires further investigation.https://www.ahajournals.org/doi/10.1161/JAHA.121.021654heart failureheart failure with preserved ejection fractionheart failure with reduced ejection fractionnonalcoholic fatty liver disease |
| spellingShingle | Marat Fudim Lin Zhong Kershaw V. Patel Rohan Khera Manal F. Abdelmalek Anna Mae Diehl Robert W. McGarrah Jeroen Molinger Cynthia A. Moylan Vishal N. Rao Kara Wegermann Ian J. Neeland Ethan A. Halm Sandeep R. Das Ambarish Pandey Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction nonalcoholic fatty liver disease |
| title | Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries |
| title_full | Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries |
| title_fullStr | Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries |
| title_full_unstemmed | Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries |
| title_short | Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries |
| title_sort | nonalcoholic fatty liver disease and risk of heart failure among medicare beneficiaries |
| topic | heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction nonalcoholic fatty liver disease |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.121.021654 |
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