Atrial fibrillation in the Malmö diet and cancer study: a study of occurrence, risk factors and diagnostic validity
Abstract
The validity of atrial fibrillation (AF) diagnoses in national registers for use as endpoints in prospective studies has not been evaluated. We studied the validity of AF diagnoses in Swedish national hospital discharge and cause of death registers and the occurrence of and risk factors for AF in a middle-aged Swedish population using these registers. Our study included the 30,447 individuals(age 44-73) who attended baseline visits in 1991-1996 of the Malmö Diet and Cancer study. Individuals with a first AF diagnosis were identified by record linkage with national registers. A subset of cases was randomly selected for validation by examination of electrocardiograms and patient records. Electrocardiograms were available in 98%of the validation sample (95% definitive AF, 3% no AF).The 2% with ECGs unavailable had probable AF. Baseline AF prevalence was 1.3%, higher in men and increased with age. During 11.2 years of follow-up 1430 first AF diagnoses occurred. Risk factors were age, hypertension, BMI,diabetes, history of heart failure, history of myocardial infarction and, in men but not women, current smoking.The strongest risk factors were history of heart failure(hazard ratio men 4.5, women 8.7) and myocardial infarction(hazard ratio men 2.0, women 1.8). The largest population-attributable risks were observed for hypertension (men 38%, women 34%) and obesity (men 11%, women 10%).In conclusion, case misclassification of AF in national registers is small, indicating feasibility of use in prospective studies. Hypertension and obesity account for large portions of population risk in middle-aged individuals with low prevalence of manifest cardiac disease.
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The incidence rate of AF might have been underestimated because ICD code information was derived from hospitalized participants and did not include AF diagnosis by general practitioners.
“Although incident AF have been well validated in this study,28 the incidence rate might have been underestimated because ICD code information was derived from hospitalized participants and did not include AF diagnosis by general practitioners.”
From Twelve-single nucleotide polymorphism genetic risk score identifies individuals at increased risk for future atrial fibrillation and stroke (2014) · cites this paper as [28]
The definition of atrial fibrillation used in the study had a 94% validation rate from ECG records.
“This definition of atrial fibrillation was shown to have a 94% validation rate from ECG records.28”
From Twelve-single nucleotide polymorphism genetic risk score identifies individuals at increased risk for future atrial fibrillation and stroke (2014) · cites this paper as [28]
Incident AF has been well validated in this study.
“Although incident AF have been well validated in this study,28”
From Twelve-single nucleotide polymorphism genetic risk score identifies individuals at increased risk for future atrial fibrillation and stroke (2014) · cites this paper as [28]
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- Authors
- Smith, J. G., Platonov, P. G., Hedblad, B., Engström, G., & Melander, O.
- Affiliations
- Lund University (SE)
- Corresponding author
- Smith, J. Gustav
- Venue
- European Journal of Epidemiology
- Published
- 2009-11-21
- Volume
- 25
- Issue
- 2
- Pages
- 95-102
- ISSN
- 0393-2990 (ISSN-L)
- 1573-7284
- OpenAlex
- W2067408747
- Cited by
- 275
- References
- 33
- Citations by year
- 2026: 6 · 2025: 8 · 2024: 13 · 2023: 12 · 2022: 4 · 2021: 19 · 2020: 24 · 2019: 23 · 2018: 18 · 2017: 25 · 2016: 18 · 2015: 20 · 2014: 25 · 2013: 22 · 2012: 19
- FWCI
- 7.98
- Type
- journal article
- Language
- en
- Open access
- closed
- Licence
- www.springer.com/tdm (tdm)
- Locations
- European Journal of Epidemiology (publishedVersion)
- PubMed (publishedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Funders
- Hjärt-Lungfonden
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiovascular Health and Risk Factors
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, diagnostic validity, hospital discharge registry, cause of death register, risk factors, heart failure, myocardial infarction, hypertension, obesity, smoking, diabetes mellitus, middle-aged adults, population attributable risk, Malmö Diet and Cancer Study
- MeSH terms
- Adult, Aged, Atrial Fibrillation, Diet, Electrocardiography, Female, Humans, Male, Medical Record Linkage, Medical Records, Middle Aged, Neoplasms, Prospective Studies, Registries, Risk Factors, Sweden, Bias, Prevalence, Logistic Models, Age Distribution, Sex Distribution
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