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...

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Autores principales:	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
Formato:	article
Lenguaje:	EN
Publicado:	Wiley 2021
Materias:	heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction nonalcoholic fatty liver disease Diseases of the circulatory (Cardiovascular) system RC666-701
Acceso en línea:	https://doaj.org/article/0348b254322045d6b98f37ff6e5d05af
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spelling	oai:doaj.org-article:0348b254322045d6b98f37ff6e5d05af2021-11-16T10:22:43ZNonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries10.1161/JAHA.121.0216542047-9980https://doaj.org/article/0348b254322045d6b98f37ff6e5d05af2021-11-01T00:00:00Zhttps://www.ahajournals.org/doi/10.1161/JAHA.121.021654https://doaj.org/toc/2047-9980Background 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.Marat FudimLin ZhongKershaw V. PatelRohan KheraManal F. AbdelmalekAnna Mae DiehlRobert W. McGarrahJeroen MolingerCynthia A. MoylanVishal N. RaoKara WegermannIan J. NeelandEthan A. HalmSandeep R. DasAmbarish PandeyWileyarticleheart failureheart failure with preserved ejection fractionheart failure with reduced ejection fractionnonalcoholic fatty liver diseaseDiseases of the circulatory (Cardiovascular) systemRC666-701ENJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease, Vol 10, Iss 22 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction nonalcoholic fatty liver disease Diseases of the circulatory (Cardiovascular) system RC666-701
spellingShingle	heart failure heart failure with preserved ejection fraction heart failure with reduced ejection fraction nonalcoholic fatty liver disease Diseases of the circulatory (Cardiovascular) system RC666-701 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
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.
format	article
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
title	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_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_sort	nonalcoholic fatty liver disease and risk of heart failure among medicare beneficiaries
publisher	Wiley
publishDate	2021
url	https://doaj.org/article/0348b254322045d6b98f37ff6e5d05af
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Nonalcoholic Fatty Liver Disease and Risk of Heart Failure Among Medicare Beneficiaries

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