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Validation of an atrial fibrillation risk algorithm in whites and African Americans

Authors :
Vilmundur Gudnason
Astrid Suchy-Dicey
Richard A. Kronmal
Tamara B. Harris
Thomas J. Wang
Michael J. Pencina
Guo Li
Daniel Levy
Philip A. Wolf
Susan R. Heckbert
Bruce M. Psaty
Lisa M. Sullivan
Thor Aspelund
Gregory L. Burke
Ramachandran S. Vasan
Lenore J. Launer
William B. Kannel
Emelia J. Benjamin
Renate B. Schnabel
Ralph B. D'Agostino
Source :
Archives of internal medicine. 170(21)
Publication Year :
2010

Abstract

Background We sought to validate a recently published risk algorithm for incident atrial fibrillation (AF) in independent cohorts and other racial groups. Methods 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. Results 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. Conclusions 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.

Details

ISSN :
15383679
Volume :
170
Issue :
21
Database :
OpenAIRE
Journal :
Archives of internal medicine
Accession number :
edsair.doi.dedup.....375d160812cc794bae9add5cd848e7eb