Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium

Alvaro Alonso, Bouwe P Krijthe, Thor Aspelund, Katherine A Stepas, Michael J Pencina, Carlee B Moser, Moritz F Sinner, Nona Sotoodehnia, João D Fontes, A Cecile J W Janssens, Richard A Kronmal, Jared W Magnani, Jacqueline C Witteman, Alanna M Chamberlain, Steven A Lubitz, Renate B Schnabel, Sunil K Agarwal, David D McManus, Patrick T Ellinor, Martin G Larson, Gregory L Burke, Lenore J Launer, Albert Hofman, Daniel Levy, John S Gottdiener, Stefan Kääb, David Couper, Tamara B Harris, Elsayed Z Soliman, Bruno H C Stricker, Vilmundur Gudnason, Susan R Heckbert, Emelia J Benjamin, Alvaro Alonso, Bouwe P Krijthe, Thor Aspelund, Katherine A Stepas, Michael J Pencina, Carlee B Moser, Moritz F Sinner, Nona Sotoodehnia, João D Fontes, A Cecile J W Janssens, Richard A Kronmal, Jared W Magnani, Jacqueline C Witteman, Alanna M Chamberlain, Steven A Lubitz, Renate B Schnabel, Sunil K Agarwal, David D McManus, Patrick T Ellinor, Martin G Larson, Gregory L Burke, Lenore J Launer, Albert Hofman, Daniel Levy, John S Gottdiener, Stefan Kääb, David Couper, Tamara B Harris, Elsayed Z Soliman, Bruno H C Stricker, Vilmundur Gudnason, Susan R Heckbert, Emelia J Benjamin

Abstract

Background: Tools for the prediction of atrial fibrillation (AF) may identify high-risk individuals more likely to benefit from preventive interventions and serve as a benchmark to test novel putative risk factors.

Methods and results: Individual-level data from 3 large cohorts in the United States (Atherosclerosis Risk in Communities [ARIC] study, the Cardiovascular Health Study [CHS], and the Framingham Heart Study [FHS]), including 18 556 men and women aged 46 to 94 years (19% African Americans, 81% whites) were pooled to derive predictive models for AF using clinical variables. Validation of the derived models was performed in 7672 participants from the Age, Gene and Environment-Reykjavik study (AGES) and the Rotterdam Study (RS). The analysis included 1186 incident AF cases in the derivation cohorts and 585 in the validation cohorts. A simple 5-year predictive model including the variables age, race, height, weight, systolic and diastolic blood pressure, current smoking, use of antihypertensive medication, diabetes, and history of myocardial infarction and heart failure had good discrimination (C-statistic, 0.765; 95% CI, 0.748 to 0.781). Addition of variables from the electrocardiogram did not improve the overall model discrimination (C-statistic, 0.767; 95% CI, 0.750 to 0.783; categorical net reclassification improvement, -0.0032; 95% CI, -0.0178 to 0.0113). In the validation cohorts, discrimination was acceptable (AGES C-statistic, 0.664; 95% CI, 0.632 to 0.697 and RS C-statistic, 0.705; 95% CI, 0.664 to 0.747) and calibration was adequate.

Conclusion: A risk model including variables readily available in primary care settings adequately predicted AF in diverse populations from the United States and Europe.

Figures

Figure 1.
Figure 1.
Distribution of predicted 5‐year risk of AF in the derivation cohorts by race using the Cohorts for Heart and Aging Research in Genomic Epidemiology atrial fibrillation (CHARGE‐AF) simple score.
Figure 2.
Figure 2.
Calibration plots for the Cohorts for Heart and Aging Research in Genomic Epidemiology atrial fibrillation (CHARGE‐AF) simple score model in the combined derivation cohorts, by race. The x‐axis refers to deciles of predicted AF risk. Each bar in the graph represents the average observed and predicted AF risk.

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