Risk factors

Many different conditions may predispose to heart failure:

• acute heart failure:
• ischemic heart disease - acute coronary syndromes, mechanical complications of acute MI
• valvular - stenosis, regurgitation, endocarditis
• hypertension/arrhythmia
• circulatory failure - septicaemia, thyrotoxicosis, pulmonary embolism
• decompensation of pre-existing chronic HF - cerebrovascular insults, infections
• chronic heart failure:
• conditions that damage heart muscle or limit its ability to function normally:
  • coronary artery disease - commonest
  • hypertension - next most common cause
  • cardiomyopthy
  • drugs – beta blockers, calcium antagonists, antiarrhythmics, cytotoxic agents
  • toxins - alcohol, drugs, cocaine, mercury, cobalt, arsenic
  • endocrine - diabetes, hypo/hyperthyroidism, Cushing's syndrome
  • infiltrative conditions – sarcoidosis, amyloidosis
  • other conditions – Chagas’ disease, HIV infection
• HF secondary to high cardiac output conditions
  • anaemia
  • thyrotoxicosis
  • septicaemia
  • liver failure
  • arteriovenous shunts (1)

Notes (2):

• hypertension, diabetes, smoking history, and previous myocardial infarction conferred a greater relative risk of heart failure in younger than in older people
• risk factors had greater discriminatory value in predicting new onset of heart failure in younger than in older people
• a greater proportion of the overall population attributable risk was explained by diabetes, smoking history, and previous myocardial infarction in younger than in older people

Reference:

• (1) European Society of Cardiology (ESC) 2008. ESC guidelines for the diagnosis and treatment of acute and chronic heart failure 2008
• (2) Tromp J et al.Age dependent associations of risk factors with heart failure: pooled population based cohort study.BMJ 2021; 372 doi: https://doi.org/10.1136/bmj.n461