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Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study

Open access
Schnabel, Renate B, Sullivan, Lisa M, Levy, Daniel, Pencina, Michael J, Massaro, Joseph M, D'Agostino, Ralph B, Newton-Cheh, Christopher, Yamamoto, Jennifer F, Magnani, Jared W, Tadros, Thomas M, Kannel, William B, Wang, Thomas J, Ellinor, Patrick T, Wolf, Philip A, Vasan, Ramachandran S, Benjamin, Emelia J·2009·The Lancet

Abstract

Background Atrial fibrillation (AF) contributes to substantial increases in morbidity and mortality. Our aim was to develop a risk prediction model to assess individuals’ absolute risk for incident AF; to offer clinicians a tool to communicate risk; and to provide researchers a framework to evaluate new risk markers. Methods We examined 4764 Framingham Heart Study individuals (8044 person-exams; mean age 60.9 years, 55% women) aged 45–95 years. Multivariable Cox regression related clinical variables to 10-year AF incidence (n=457). Secondary analyses incorporated routine echocardiographic data (person-exams=7156, 445 events) for reclassifying individuals’ AF risk. Findings Age, sex, significant murmur, heart failure, systolic blood pressure, hypertension treatment, body mass index, and electrocardiographic PR interval were associated with incident AF (p<0.05; clinical model C statistic=0.78, 95% confidence interval [CI] 0.76–0.80). Ten-year AF risk varied with age; >15% 10-year AF risk was observed in 1.0% of individuals <65 years versus 26.9% of participants ≥65 years. Predicted 10-year risk deciles for developing AF were similar to observed risks (calibration Chi-square statistic, 4.16, p=0.90). Additional incorporation of echocardiographic features minimally improved the C statistic from 0.78 (0.75, 0.80) to 0.79 (95% CI 0.77–0.82), p=0.005. Echocardiographic variables did not significantly improve net reclassification (p=0.18). We provide a point score for estimating AF risk with variables easily-measured in primary care. Interpretation The Framingham AF risk score may help risk stratify individuals in the community, and may provide a framework to evaluate new biological or genetic markers for AF risk prediction and help target individuals destined to develop AF for preventive measures.

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Metadata

Authors
Schnabel, R. B., Sullivan, L. M., Levy, D., Pencina, M. J., Massaro, J. M., D'Agostino, R. B., Newton-Cheh, C., Yamamoto, J. F., Magnani, J. W., Tadros, T. M., Kannel, W. B., Wang, T. J., Ellinor, P. T., Wolf, P. A., Vasan, R. S., & Benjamin, E. J.
Venue
The Lancet
Publisher
Elsevier BV
Published
2009-02
Volume
373
Issue
9665
Pages
739-745
ISSN
  • 0099-5355 (ISSN-L)
  • 0140-6736
OpenAlex
W2167813229
Cited by
1,041
References
13
FWCI
35.98
Type
journal article
Language
en
Open access
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Schnabel, R. B., Sullivan, L. M., Levy, D., Pencina, M. J., Massaro, J. M., D'Agostino, R. B., Newton-Cheh, C., Yamamoto, J. F., Magnani, J. W., Tadros, T. M., Kannel, W. B., Wang, T. J., Ellinor, P. T., Wolf, P. A., Vasan, R. S., & Benjamin, E. J. (2009). Development of a risk score for atrial fibrillation (Framingham Heart Study): a community-based cohort study. The Lancet. https://doi.org/10.1016/s0140-6736(09)60443-8

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Contains information from the Semantic Scholar Academic Graph Datasets, made available under the ODC Attribution License (ODC-BY 1.0).

Semantic Scholar’s data is described in: Kinney, R., et al. (2023). The Semantic Scholar Open Data Platform. arXiv:2301.10140.