Risk calculator for incident atrial fibrillation across a range of prediction horizons - 04/05/24
, Yoko M. Nakao, MD b, c, e, Kazuhiro Nakao, MD b, c, f, Ronen Arbel, PhD g, h, Moti Haim, MD i, j, Doron Zahger, MD i, j, Gregory Y. H. Lip, MD k, l, J Campbell Cowan, DPhil d, Chris P. Gale, PhD c, d, eABSTRACT |
Background |
The increasing burden of atrial fibrillation (AF) emphasizes the need to identify high-risk individuals for enrolment in clinical trials of AF screening and primary prevention. We aimed to develop prediction models to identify individuals at high-risk of AF across prediction horizons from 6-months to 10-years.
Methods |
We used secondary-care linked primary care electronic health record data from individuals aged ≥30 years without known AF in the UK Clinical Practice Research Datalink-GOLD dataset between January 2, 1998 and November 30, 2018; randomly divided into derivation (80%) and validation (20%) datasets. Models were derived using logistic regression from known AF risk factors for incident AF in prediction periods of 6 months, 1-year, 2-years, 5-years, and 10-years. Performance was evaluated using in the validation dataset with bootstrap validation with 200 samples, and compared against the CHA2DS2-VASc and C2HEST scores.
Results |
Of 2,081,139 individuals in the cohort (1,664,911 in the development dataset, 416,228 in the validation dataset), the mean age was 49.9 (SD 15.4), 50.7% were women, and 86.7% were white. New cases of AF were 7,386 (0.4%) within 6 months, 15,349 (0.7%) in 1 year, 38,487 (1.8%) in 5 years, and 79,997 (3.8%) by 10 years. Valvular heart disease and heart failure were the strongest predictors, and association of hypertension with AF increased at longer prediction horizons. The optimal risk models incorporated age, sex, ethnicity, and 8 comorbidities. The models demonstrated good-to-excellent discrimination and strong calibration across prediction horizons (AUROC, 95%CI, calibration slope: 6-months, 0.803, 0.789-0.821, 0.952; 1-year, 0.807, 0.794-0.819, 0.962; 2-years, 0.815, 0.807-0.823, 0.973; 5-years, 0.807, 0.803-0.812, 1.000; 10-years 0.780, 0.777-0.784, 1.010), and superior to the CHA2DS2-VASc and C2HEST scores. The models are available as a web-based FIND-AF calculator.
Conclusions |
The FIND-AF models demonstrate high discrimination and calibration across short- and long-term prediction horizons in 2 million individuals. Their utility to inform trial enrolment and clinical decisions for AF screening and primary prevention requires further study.
Le texte complet de cet article est disponible en PDF.Graphical Abstract |
Plan
Vol 272
P. 1-10 - juin 2024 Retour au numéro
Article précédent
- Prospective randomized double-blind study to evaluate the superiority of Vasopressin versus Norepinephrine in the management of the patient at renal risk undergoing cardiac surgery with cardiopulmonary bypass (NOVACC trial)
- Pierre-Grégoire Guinot, Olivier Desebbe, Guillaume Besch, Philippe Guerci, Philippe Gaudard, Diane Lena, Paul Michel Mertes, Osama Abou-Arab, Belaid Bouhemad, NOVACC study group, Maxime Nguyen, Bastien Durand, Audrey Martin, Vivien Berthoud, Tiberiu Constandache, Sandrine Grosjean, Mohamed Radhouani, Jean-Baptiste Anciaux, Pierre Voizeux, Anouck Appriou, Valentin Kabout, Jules Marcand, Florian Nays, Maxime Guilhot, Rudy Alardin, Dejan Ilic, Thomas Senot, Beyls Christophe, Bayart Guillaume, Lagarde Clément, Leviel Florent, Lefebvre Thomas, Haye Guillaume, Huguetto Aurore, David Helene, Grelet Tommy, Pereira Lucas, Zaepffel Zoé, Guilhot Maxime, Bataillard Amélie, Alardin Rudy, Senot Thomas, Jelicic Aleksandra, Ilic Dejan, Tissot Michel, Fouace Charles
- Ticagrelor with or without aspirin following percutaneous coronary intervention in high-risk patients with concomitant peripheral artery disease: A subgroup analysis of the TWILIGHT randomized clinical trial
- Mitchell Krucoff, Alessandro Spirito, Usman Baber, Samantha Sartori, Dominick J. Angiolillo, Carlo Briguori, David J. Cohen, Timothy Collier, George Dangas, Dariusz Dudek, Javier Escaned, C. Michael Gibson, Ya-Ling Han, Kurt Huber, Adnan Kastrati, Upendra Kaul, Ran Kornowski, Vijay Kunadian, Birgit Vogel, Shamir R. Mehta, David Moliterno, Gennaro Sardella, Richard A. Shlofmitz, Samin Sharma, Philippe Gabriel Steg, Stuart Pocock, Roxana Mehran
Bienvenue sur EM-consulte, la référence des professionnels de santé.
L’accès au texte intégral de cet article nécessite un abonnement.
Déjà abonné à cette revue ?