Risk assessment for incident heart failure in individuals with atrial fibrillation
Department of Medicine, Division of Cardiovascular Medicine; Meyers Primary Care Institute
Atrial Fibrillation; Incidence; Heart Failure
Cardiology | Cardiovascular Diseases | Clinical Epidemiology | Epidemiology | Health Services Research
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 chi2 statistic 7.29; Pchi2 = 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.
DOI of Published Version
Schnabel RB, Rienstra M, Sullivan LM, Sun JX, Moser CB, Levy D, Pencina MJ, Fontes JD, Magnani JW, McManus DD, Lubitz SA, Tadros TM, Wang TJ, Ellinor PT, Vasan RS, Benjamin EJ. Risk assessment for incident heart failure in individuals with atrial fibrillation. Eur J Heart Fail. 2013 Aug;15(8):843-9. doi:10.1093/eurjhf/hft041. Link to article on publisher's site
European journal of heart failure
Schnabel, Renate B.; Rienstra, Michiel; Sullivan, Lisa M.; Sun, Jenny X.; Moser, Carlee B.; Levy, Daniel; Pencina, Michael J.; Fontes, Joao D.; Magnani, Jared W.; McManus, David D.; Lubitz, Steven A.; Tadros, Thomas M.; Eang, Thomas J.; Ellinor, Patrick T.; Vasan, Ramachandran S.; and Benjamin, Emelia J., "Risk assessment for incident heart failure in individuals with atrial fibrillation" (2013). Meyers Primary Care Institute Publications and Presentations. 653.