Abstract 16663: Premature Ventricular Contractions and Incident Heart Failure: Identifying Risk Factors via Interaction Analyses

Abstract

Introduction: Premature ventricular contraction (PVC)-induced cardiomyopathy is a potentially reversible cause of heart failure (HF). The association between PVCs and HF has been limited to case reports and small observational studies. Our objective was to leverage a large population-based database to examine interactions that might prove clinically useful in risk stratification. Methods: We included adult patients free of structural heart disease in the California Healthcare Cost and Utilization Project (HCUP) database from 2005-2009. After excluding patients with prevalent cardiomyopathy or heart failure, we identified patients with a diagnosis of PVCs. The primary outcome was incident systolic HF. Results: Among 16.8 million patients experiencing 48.1 million hospitalizations, 35,817 (0.2%) had a PVC diagnosis, and 198,818 (1.2%) developed systolic HF during study follow-up. After adjustment for age, sex, race, income & known HF risk factors, PVCs were an independent predictor of systolic HF [Hazard Ratio (HR) 1.57, 95% CI 1.51-1.63, p-value<0.001]. Interaction analyses revealed that relationship between PVCs and incident systolic HF was especially strong among younger patients and in those without coronary artery disease (CAD), hypertension (HTN), diabetes mellitus (DM) or atrial fibrillation (AF) [Table 1]. In patients <65 years without HTN, DM, CAD or AF, a PVC diagnosis was associated with an over 6-fold increase in incident HF risk (HR 6.5, 95% CI 5.5-7.7, p<0.001). Conclusion: Using a large population-based database, we found that a diagnosis of PVCs predicts incident systolic HF even after adjusting for conventional risk factors. This effect is most pronounced in younger patients, and those without HTN, DM, CAD or AF, suggesting that PVCs impart the greatest risk for heart failure when other cardiac comorbidities are absent.