Risk assessment for incident heart failure in individuals with atrial fibrillation.

Published

Journal Article

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.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.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.

Full Text

Duke Authors

Cited Authors

  • 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

Published Date

  • August 2013

Published In

Volume / Issue

  • 15 / 8

Start / End Page

  • 843 - 849

PubMed ID

  • 23594831

Pubmed Central ID

  • 23594831

Electronic International Standard Serial Number (EISSN)

  • 1879-0844

International Standard Serial Number (ISSN)

  • 1388-9842

Digital Object Identifier (DOI)

  • 10.1093/eurjhf/hft041

Language

  • eng