Risk assessment for incident heart failure in individuals with atrial fibrillation

TY - JOUR

T1 - Risk assessment for incident heart failure in individuals with atrial fibrillation

AU - Schnabel, Renate B

AU - Rienstra, Michiel

AU - Sullivan, Lisa M

AU - Sun, Jenny X

AU - Moser, Carlee B

AU - Levy, Daniel

AU - Pencina, Michael J

AU - Fontes, João D

AU - Magnani, Jared W

AU - McManus, David D

AU - Lubitz, Steven A

AU - Tadros, Thomas M

AU - Wang, Thomas J

AU - Ellinor, Patrick T

AU - Vasan, Ramachandran S

AU - Benjamin, Emelia J

PY - 2013/8

Y1 - 2013/8

N2 - BACKGROUND: Atrial fibrillation (AF) is a strong risk factor for heart failure (HF); HF onset in patients with AF is associated with increased morbidity and mortality. Risk factors that predict HF in individuals with AF in the community are not well established.METHODS AND RESULTS: We examined clinical variables related to the 10-year incidence of HF in 725 individuals (mean 73.3 years, 45% women) with documented AF in the Framingham Heart Study. Event rates for incident HF (n = 161, 48% in women) were comparable in women (4.30 per 100 person-years) and men (3.34 per 100 person-years). Age, body mass index, ECG LV hypertrophy, diabetes, significant murmur, and history of myocardial infarction were positively associated with incident HF in multivariable models (C-statistic 0.71; 95% confidence interval 0.67-0.75). We developed a risk algorithm for estimating absolute risk of HF in AF patients with good model fit and calibration (adjusted calibration χ2 statistic 7.29; P(χ2) = 0.61). Applying the algorithm, 47.6% of HF events occurred in the top tertile in men compared with 13.1% in the bottom tertile, and 58.4% in women in the upper tertile compared with 18.2% in the lowest category. For HF type, women had a non-significantly higher incidence of HF with preserved EF compared with men.CONCLUSIONS: We describe advancing age, LV hypertrophy, body mass index, diabetes, significant heart murmur, and history of myocardial infarction as clinical predictors of incident HF in individuals with AF. A risk algorithm may help identify individuals with AF at high risk of developing HF.

AB - BACKGROUND: Atrial fibrillation (AF) is a strong risk factor for heart failure (HF); HF onset in patients with AF is associated with increased morbidity and mortality. Risk factors that predict HF in individuals with AF in the community are not well established.METHODS AND RESULTS: We examined clinical variables related to the 10-year incidence of HF in 725 individuals (mean 73.3 years, 45% women) with documented AF in the Framingham Heart Study. Event rates for incident HF (n = 161, 48% in women) were comparable in women (4.30 per 100 person-years) and men (3.34 per 100 person-years). Age, body mass index, ECG LV hypertrophy, diabetes, significant murmur, and history of myocardial infarction were positively associated with incident HF in multivariable models (C-statistic 0.71; 95% confidence interval 0.67-0.75). We developed a risk algorithm for estimating absolute risk of HF in AF patients with good model fit and calibration (adjusted calibration χ2 statistic 7.29; P(χ2) = 0.61). Applying the algorithm, 47.6% of HF events occurred in the top tertile in men compared with 13.1% in the bottom tertile, and 58.4% in women in the upper tertile compared with 18.2% in the lowest category. For HF type, women had a non-significantly higher incidence of HF with preserved EF compared with men.CONCLUSIONS: We describe advancing age, LV hypertrophy, body mass index, diabetes, significant heart murmur, and history of myocardial infarction as clinical predictors of incident HF in individuals with AF. A risk algorithm may help identify individuals with AF at high risk of developing HF.

KW - Adult

KW - Age Factors

KW - Aged

KW - Aged, 80 and over

KW - Algorithms

KW - Atrial Fibrillation/epidemiology

KW - Body Mass Index

KW - Cohort Studies

KW - Diabetes Mellitus/epidemiology

KW - Female

KW - Heart Failure/epidemiology

KW - Heart Murmurs/epidemiology

KW - Humans

KW - Hypertrophy, Left Ventricular/epidemiology

KW - Incidence

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Myocardial Infarction/epidemiology

KW - Overweight/epidemiology

KW - Proportional Hazards Models

KW - Risk Assessment/methods

KW - Risk Factors

U2 - 10.1093/eurjhf/hft041

DO - 10.1093/eurjhf/hft041

M3 - SCORING: Journal article

C2 - 23594831

VL - 15

SP - 843

EP - 849

JO - EUR J HEART FAIL

JF - EUR J HEART FAIL

SN - 1388-9842

IS - 8

ER -