title: Simple risk model predicts incidence of atrial fibrillation in a racially and geographically diverse population: the CHARGE-AF consortium.
abstract: BACKGROUND
  Tools for the prediction of atrial fibrillation (AF) may identify high-risk individuals more likely to benefit from preventive interventions and serve as a benchmark to test novel putative risk factors.
  
  
  RESULTS
  Individual-level data from 3 large cohorts in the United States (Atherosclerosis Risk in Communities [ARIC] study, the Cardiovascular Health Study [CHS], and the Framingham Heart Study [FHS]), including 18 556 men and women aged 46 to 94 years (19% African Americans, 81% whites) were pooled to derive predictive models for AF using clinical variables. Validation of the derived models was performed in 7672 participants from the Age, Gene and Environment-Reykjavik study (AGES) and the Rotterdam Study (RS). The analysis included 1186 incident AF cases in the derivation cohorts and 585 in the validation cohorts. A simple 5-year predictive model including the variables age, race, height, weight, systolic and diastolic blood pressure, current smoking, use of antihypertensive medication, diabetes, and history of myocardial infarction and heart failure had good discrimination (C-statistic, 0.765; 95% CI, 0.748 to 0.781). Addition of variables from the electrocardiogram did not improve the overall model discrimination (C-statistic, 0.767; 95% CI, 0.750 to 0.783; categorical net reclassification improvement, -0.0032; 95% CI, -0.0178 to 0.0113). In the validation cohorts, discrimination was acceptable (AGES C-statistic, 0.664; 95% CI, 0.632 to 0.697 and RS C-statistic, 0.705; 95% CI, 0.664 to 0.747) and calibration was adequate.
  
  
  CONCLUSIONS
  A risk model including variables readily available in primary care settings adequately predicted AF in diverse populations from the United States and Europe.
authors.affiliation: Division of Epidemiology and Community Health, School of Public Health, University of Minnesota, Minneapolis, MN 55454, USA. alonso@umn.edu
authors.forename: Alvaro
authors.initials: A
authors.lastname: Alonso
authors.forename: Bouwe P
authors.initials: BP
authors.lastname: Krijthe
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.forename: Katherine A
authors.initials: KA
authors.lastname: Stepas
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Pencina
authors.forename: Carlee B
authors.initials: CB
authors.lastname: Moser
authors.forename: Moritz F
authors.initials: MF
authors.lastname: Sinner
authors.forename: Nona
authors.initials: N
authors.lastname: Sotoodehnia
authors.forename: João D
authors.initials: JD
authors.lastname: Fontes
authors.forename: A Cecile J W
authors.initials: AC
authors.lastname: Janssens
authors.forename: Richard A
authors.initials: RA
authors.lastname: Kronmal
authors.forename: Jared W
authors.initials: JW
authors.lastname: Magnani
authors.forename: Jacqueline C
authors.initials: JC
authors.lastname: Witteman
authors.forename: Alanna M
authors.initials: AM
authors.lastname: Chamberlain
authors.forename: Steven A
authors.initials: SA
authors.lastname: Lubitz
authors.forename: Renate B
authors.initials: RB
authors.lastname: Schnabel
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Agarwal
authors.forename: David D
authors.initials: DD
authors.lastname: McManus
authors.forename: Patrick T
authors.initials: PT
authors.lastname: Ellinor
authors.forename: Martin G
authors.initials: MG
authors.lastname: Larson
authors.forename: Gregory L
authors.initials: GL
authors.lastname: Burke
authors.forename: Lenore J
authors.initials: LJ
authors.lastname: Launer
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Daniel
authors.initials: D
authors.lastname: Levy
authors.forename: John S
authors.initials: JS
authors.lastname: Gottdiener
authors.forename: Stefan
authors.initials: S
authors.lastname: Kääb
authors.forename: David
authors.initials: D
authors.lastname: Couper
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Elsayed Z
authors.initials: EZ
authors.lastname: Soliman
authors.forename: Bruno H C
authors.initials: BH
authors.lastname: Stricker
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.forename: Emelia J
authors.initials: EJ
authors.lastname: Benjamin
mesh_terms: D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000453:epidemiology* / Q000208:ethnology; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D006973:Hypertension / Q000453:epidemiology; D007055:Iceland / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D009426:Netherlands / Q000453:epidemiology; D016016:Proportional Hazards Models; D018570:Risk Assessment / Q000379:methods*; D012907:Smoking / Q000453:epidemiology; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
references.citation: Circulation. 1998 May 12;97(18):1837-47
references.pmid: 9603539
references.citation: Am J Epidemiol. 1989 Apr;129(4):687-702
references.pmid: 2646917
references.citation: Stat Med. 2008 Jan 30;27(2):157-72; discussion 207-12
references.pmid: 17569110
references.citation: J Am Coll Cardiol. 2008 Feb 26;51(8):779-86
references.pmid: 18294560
references.citation: Arch Intern Med. 2006 Nov 27;166(21):2322-8
references.pmid: 17130384
references.citation: Ann Intern Med. 1999 Mar 16;130(6):461-70
references.pmid: 10075613
references.citation: Eur J Epidemiol. 2009;24(9):553-72
references.pmid: 19728115
references.citation: Circ Cardiovasc Qual Outcomes. 2011 May;4(3):313-20
references.pmid: 21540439
references.citation: JAMA. 2004 Nov 24;292(20):2471-7
references.pmid: 15562125
references.citation: Arch Intern Med. 1998 Feb 9;158(3):229-34
references.pmid: 9472202
references.citation: Arch Intern Med. 2010 Nov 22;170(21):1909-17
references.pmid: 21098350
references.citation: Circ Arrhythm Electrophysiol. 2012 Feb;5(1):155-62
references.pmid: 22227953
references.citation: JAMA. 2001 Jul 11;286(2):180-7
references.pmid: 11448281
references.citation: J Gen Intern Med. 2010 Aug;25(8):853-8
references.pmid: 20405332
references.citation: Circ Cardiovasc Genet. 2009 Feb;2(1):73-80
references.pmid: 20031568
references.citation: Circulation. 2008 Feb 12;117(6):743-53
references.pmid: 18212285
references.citation: Stat Med. 2004 Jul 15;23(13):2109-23
references.pmid: 15211606
references.citation: Ann Epidemiol. 1991 Feb;1(3):263-76
references.pmid: 1669507
references.citation: Prev Med. 1975 Dec;4(4):518-25
references.pmid: 1208363
references.citation: JAMA. 1994 Mar 16;271(11):840-4
references.pmid: 8114238
references.citation: Eur J Epidemiol. 2007;22(11):819-29
references.pmid: 17955331
references.citation: J Clin Epidemiol. 2003 Sep;56(9):880-90
references.pmid: 14505774
references.citation: Am J Med Sci. 2010 Oct;340(4):271-5
references.pmid: 20881756
references.citation: Circ Heart Fail. 2012 Jul 1;5(4):422-9
references.pmid: 22589298
references.citation: Am J Epidemiol. 2007 May 1;165(9):1076-87
references.pmid: 17351290
references.citation: JAMA. 2001 May 9;285(18):2370-5
references.pmid: 11343485
references.citation: Scand Cardiovasc J. 2012 Jun;46(3):149-53
references.pmid: 22397620
references.citation: Eur Heart J. 2006 Apr;27(8):949-53
references.pmid: 16527828
references.citation: Arch Intern Med. 1999 Jun 14;159(11):1197-204
references.pmid: 10371227
references.citation: Am J Cardiol. 2011 Jan;107(1):85-91
references.pmid: 21146692
references.citation: Lancet. 2009 Feb 28;373(9665):739-45
references.pmid: 19249635
references.citation: Am J Cardiol. 2004 Mar 1;93(5):647-9
references.pmid: 14996602
references.citation: Circulation. 1997 Oct 7;96(7):2455-61
references.pmid: 9337224
references.citation: Pharmacoepidemiol Drug Saf. 2012 Jan;21 Suppl 1:141-7
references.pmid: 22262600
references.citation: Am Heart J. 2010 May;159(5):850-6
references.pmid: 20435195
references.citation: Am Heart J. 2009 Jul;158(1):111-7
references.pmid: 19540400
references.citation: JAMA. 2003 Aug 27;290(8):1049-56
references.pmid: 12941677
references.citation: JAMA. 2007 Feb 21;297(7):709-15
references.pmid: 17312290