Purpose: We used a large real-world data from community settings to develop and validate a 10-year risk score for new-onset atrial fibrillation (AF) and calculate its net benefit performance.
Methods: Multivariable Cox proportional hazards model was used to estimate effects of risk factors in the derivation cohort (n = 96,778) and to derive a risk equation. Measures of calibration and discrimination were calculated in the validation cohort (n = 48,404).
Results: Cumulative AF incidence rates for both the derivation and validation cohorts were 5.8% at 10 years. The final models included the following variables: age, sex, body mass index, history of treated hypertension, systolic blood pressure ≥ 160 mm Hg, chronic lung disease, history of myocardial infarction, history of peripheral arterial disease, heart failure and history of an inflammatory disease. There was a 27-fold difference (1.0% vs. 27.2%) in AF risk between the lowest (-1) and the highest (9) sum score. The c-statistic was 0.743 (95% confidence interval [CI], 0.737-0.749) for the derivation cohort and 0.749 (95% CI, 0.741-0.759) in the validation cohort. The risk equation was well calibrated, with predicted risks closely matching observed risks. Decision curve analysis displayed consistent positive net benefit of using the AF risk score for decision thresholds between 1 and 25% 10-year AF risk.
Conclusion: We provide a simple score for the prediction of 10-year risk for AF. The score can be used to select patients at highest risk for treatments of modifiable risk factors, monitoring for sub-clinical AF detection or for clinical trials of primary prevention of AF.
Georg Thieme Verlag KG Stuttgart · New York.