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Validation of an atrial fibrillation risk algorithm in whites and African Americans.
Tuesday,2012-11-06 12:25 America/Los_Angeles — eenright
| Title | Validation of an atrial fibrillation risk algorithm in whites and African Americans. |
| Publication Type | Journal Article |
| Year of Publication | 2010 |
| Authors | Schnabel, RB, Aspelund, T, Li, G, Sullivan, LM, Suchy-Dicey, A, Harris, TB, Pencina, MJ, D'Agostino, RB, Levy, D, Kannel, WB, Wang, TJ, Kronmal, RA, Wolf, PA, Burke, GL, Launer, LJ, Vasan, RS, Psaty, BM, Benjamin, EJ, Gudnason, V, Heckbert, SR |
| Journal | Arch Intern Med |
| Volume | 170 |
| Issue | 21 |
| Pagination | 1909-17 |
| Date Published | 2010 Nov 22 |
| ISSN | 1538-3679 |
| Keywords | African Continental Ancestry Group, Age Factors, Aged, Aged, 80 and over, Algorithms, Atrial Fibrillation, Blood Pressure, Body Mass Index, Cohort Studies, Electrocardiography, Europe, European Continental Ancestry Group, Female, Follow-Up Studies, Heart Failure, Humans, Hypertension, Incidence, Kaplan-Meier Estimate, Male, Middle Aged, Proportional Hazards Models, Risk Factors, Sex Factors, Systole, United States |
| Abstract | <p><b>BACKGROUND: </b>We sought to validate a recently published risk algorithm for incident atrial fibrillation (AF) in independent cohorts and other racial groups.</p><p><b>METHODS: </b>We evaluated the performance of a Framingham Heart Study (FHS)-derived risk algorithm modified for 5-year incidence of AF in the FHS (n = 4764 participants) and 2 geographically and racially diverse cohorts in the age range 45 to 95 years: AGES (the Age, Gene/Environment Susceptibility-Reykjavik Study) (n = 4238) and CHS (the Cardiovascular Health Study) (n = 5410, of whom 874 [16.2%] were African Americans). The risk algorithm included age, sex, body mass index, systolic blood pressure, electrocardiographic PR interval, hypertension treatment, and heart failure.</p><p><b>RESULTS: </b>We found 1359 incident AF events in 100 074 person-years of follow-up. Unadjusted 5-year event rates differed by cohort (AGES, 12.8 cases/1000 person-years; CHS whites, 22.7 cases/1000 person-years; and FHS, 4.5 cases/1000 person-years) and by race (CHS African Americans, 18.4 cases/1000 person-years). The strongest risk factors in all samples were age and heart failure. The relative risks for incident AF associated with risk factors were comparable across cohorts and race groups. After recalibration for baseline incidence and risk factor distribution, the Framingham algorithm, reported in C statistic, performed reasonably well in all samples: AGES, 0.67 (95% confidence interval [CI], 0.64-0.71); CHS whites, 0.68 (95% CI, 0.66-0.70); and CHS African Americans, 0.66 (95% CI, 0.61-0.71). Risk factors combined in the algorithm explained between 47.0% (AGES) and 63.6% (FHS) of the population-attributable risk.</p><p><b>CONCLUSIONS: </b>Risk of incident AF in community-dwelling whites and African Americans can be assessed reliably by routinely available and potentially modifiable clinical variables. Seven risk factors accounted for up to 64% of risk.</p> |
| DOI | 10.1001/archinternmed.2010.434 |
| Alternate Journal | Arch. Intern. Med. |
| PubMed ID | 21098350 |
| PubMed Central ID | PMC3021784 |
| Grant List | K24 HL004334-07 / HL / NHLBI NIH HHS / United States N01-HC-25195 / HC / NHLBI NIH HHS / United States N01 HC085086 / HC / NHLBI NIH HHS / United States R01 NS017950 / NS / NINDS NIH HHS / United States R01 NS 17950 / NS / NINDS NIH HHS / United States N01AG12100 / AG / NIA NIH HHS / United States N01 AG012100 / AG / NIA NIH HHS / United States N01 HC-85080 / HC / NHLBI NIH HHS / United States N01 HC085081 / HC / NHLBI NIH HHS / United States U01 HL080295-04 / HL / NHLBI NIH HHS / United States R01 HL087652-03 / HL / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States R01 HL092577 / HL / NHLBI NIH HHS / United States R01 HL068986 / HL / NHLBI NIH HHS / United States N01 HC-85082 / HC / NHLBI NIH HHS / United States N01 HC015103 / HC / NHLBI NIH HHS / United States N01 HC085083 / HC / NHLBI NIH HHS / United States N01 HC-85085 / HC / NHLBI NIH HHS / United States N01 HC025195 / HC / NHLBI NIH HHS / United States N01 HC085085 / HC / NHLBI NIH HHS / United States N01 HC-85081 / HC / NHLBI NIH HHS / United States R01 HL087652-01 / HL / NHLBI NIH HHS / United States N01 HC-85079 / HC / NHLBI NIH HHS / United States AG029451 / AG / NIA NIH HHS / United States R01 HL087652 / HL / NHLBI NIH HHS / United States R01 HL080295-07 / HL / NHLBI NIH HHS / United States RC1 HL101056 / HL / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States R56 AG029451 / AG / NIA NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States AG028321 / AG / NIA NIH HHS / United States K24 HL004334 / HL / NHLBI NIH HHS / United States N01 HC085082 / HC / NHLBI NIH HHS / United States R01 NS017950-29 / NS / NINDS NIH HHS / United States N01 HC-85086 / HC / NHLBI NIH HHS / United States N01 HC085080 / HC / NHLBI NIH HHS / United States RC1 HL101056-01 / RC / CCR NIH HHS / United States R01 AG029451-04 / AG / NIA NIH HHS / United States N01 HC-55222 / HC / NHLBI NIH HHS / United States N01 HC-85083 / HC / NHLBI NIH HHS / United States N01 HC055222 / HC / NHLBI NIH HHS / United States R01 AG029451 / AG / NIA NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States R01 AG029451-02 / AG / NIA NIH HHS / United States R01 HL068986-06 / HL / NHLBI NIH HHS / United States K24 HL004334-08 / HL / NHLBI NIH HHS / United States N01 HC085084 / HC / NHLBI NIH HHS / United States R01 HL092577-01A1 / HL / NHLBI NIH HHS / United States N01HC25195 / HL / NHLBI NIH HHS / United States R01 AG028321-04 / AG / NIA NIH HHS / United States R01 NS017950-18 / NS / NINDS NIH HHS / United States R01 HL092577-03 / HL / NHLBI NIH HHS / United States N01 HC-85084 / HC / NHLBI NIH HHS / United States RC1 HL101056-01 / HL / NHLBI NIH HHS / United States R01 AG028321-05 / AG / NIA NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01 HC085079 / HC / NHLBI NIH HHS / United States R01 AG028321 / AG / NIA NIH HHS / United States 2K24 HL04334 / HL / NHLBI NIH HHS / United States RC1 HL101056-02 / HL / NHLBI NIH HHS / United States N01 HC035129 / HC / NHLBI NIH HHS / United States HL092577 / HL / NHLBI NIH HHS / United States |