Figure 1. Study Design, The Atherosclerosis Risk in Communities (ARIC) Study (2005–2012).

Abbreviations: Heart failure (HF), fee-for-service (FFS), acute decompensated heart failure (ADHF), chronic stable heart failure (CSHF)

^aDefinite and probable acute decompensated heart failure and chronic stable heart failure ascertained from reviewed abstracted medical records

^bAscertained from heart failure surveys sent to participant’s physicians for confirmation of heart failure diagnosis

^cCenters for Medicare and Medicaid Services Medicare claims, International Classification of Disease, 9^th Edition Clinical Modification (ICD-9-CM) code 428.x in any position present in the hospital record, ICD-9-CM 428.x in any position present in the hospital record or ICD-9-CM 428.x present in the outpatient record Self-reported heart failure ascertained from ARIC annual follow up telephone interview