Article Text

Original research
Validating risk models versus age alone for atrial fibrillation in a young Dutch population cohort: should atrial fibrillation risk prediction be expanded to younger community members?
  1. Jelle C L Himmelreich1,
  2. Ralf E Harskamp1,
  3. Bastiaan Geelhoed2,
  4. Saverio Virdone3,
  5. Wim A M Lucassen1,
  6. Ron T Gansevoort4,
  7. Michiel Rienstra2
  1. 1Department of General Practice, Amsterdam Public Health, Amsterdam UMC Locatie AMC, Amsterdam, The Netherlands
  2. 2Department of Cardiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  3. 3Department of Statistics, Thrombosis Research Institute, London, UK
  4. 4Department of Nephrology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
  1. Correspondence to Jelle C L Himmelreich; j.c.himmelreich{at}amsterdamumc.nl

Abstract

Background Advancing age is the primary selection criterion for community screening for atrial fibrillation (AF), with selection often restricted to those aged ≥65 years. If multivariable models were shown to have considerable additional value over age alone in predicting AF risk among younger individuals, AF screening could be expanded to patients with lower age, but with high AF risk as per a validated risk model.

Methods We validated risk models CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology model for AF) and FHS-AF (Framingham Heart Study model for AF), and risk scores CHA2DS2-VASc and CHA2DS2-VA, and presented their predictive abilities for 5-year and 10-year AF risk versus that of age alone in a young Dutch population cohort (PREVEND) free from AF at baseline. We assessed discrimination by the C-statistic and calibration by the calibration plot and stratified Kaplan-Meier plot using survey-weighted Cox models.

Results During 5-year and 10-year follow-up there were n=98 (2.46/1000 person-years) and n=249 (3.29/1000 person-years) new AF cases, respectively, among 8265 participants with mean age 49±13 years. CHARGE-AF and FHS-AF both showed good discrimination for 5-year and 10-year AF (C-statistic range 0.83–0.86) with accurate calibration for 5-year AF, but overestimation of 10-year AF risk in highest-risk individuals. CHA2DS2-VASc and CHA2DS2-VA relatively underperformed. Age alone showed similar discrimination to that of CHARGE-AF and FHS-AF both in the overall, young PREVEND cohort and in subgroups for lower age and lower stroke risk.

Conclusion Multivariable models accurately discriminate for 5-year and 10-year AF risk among young European community-dwelling individuals. However, their additional discriminatory value over age alone was limited. Selection strategies for primary AF screening using multivariable models should not be expanded to younger individuals.

  • thromboembolism
  • epidemiology
  • pacing & electrophysiology

Data availability statement

Data are available upon reasonable request. Requests for and information on usage of the de-identified PREVEND data set can be directed to m.rienstra@umcg.nl.

http://creativecommons.org/licenses/by-nc/4.0/

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Data availability statement

Data are available upon reasonable request. Requests for and information on usage of the de-identified PREVEND data set can be directed to m.rienstra@umcg.nl.

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Footnotes

  • JCLH and REH are joint first authors.

  • Contributors JCLH and REH performed data analysis and data presentation, were primarily responsible for manuscript preparation, and were guarantors of this work. RTG and MR supervised data collection and data preparation at UMCG, and provided valuable input to the manuscript. BG and SV assisted in data analysis, and provided valuable input to the manuscript. WAML provided valuable input to the manuscript.

  • Funding This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw) (80-83910-98-13046) and the European Research Council under the European Union’s Horizon 2020 research and innovation programme (648 131).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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