title: Validation of the Framingham Heart Study and CHARGE-AF Risk Scores for Atrial Fibrillation in Hispanics, African-Americans, and Non-Hispanic Whites.
abstract: A risk score for atrial fibrillation (AF) has been developed by the Framingham Heart Study and Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF consortium. However, validation of these risk scores in an inner-city population is uncertain. Thus, a validation model was built using the Framingham Risk Score for AF and CHARGE-AF covariates. An in and outpatient electrocardiographic database was interrogated from 2000 to 2013 for the development of AF. Patients were included if their age was >45 and <95 years, had <10-year follow-up, if their initial electrocardiogram was without AF, had ≥ 2 electrocardiograms, and declared a race and/or ethnicity as non-Hispanic white, African-American, or Hispanic. For the Framingham Heart Study, 49,599 patients met inclusion criteria, of which 4,860 developed AF. Discrimination analysis using area under the curve (AUC) for original risk equations: non-Hispanic white AUC = 0.712 (95% confidence interval [CI] 0.694 to 0.731), African-American AUC = 0.733 (95% CI 0.716 to 0.751), and Hispanic AUC = 0.740 (95% CI 0.723 to 0.757). For the CHARGE-AF, 45,571 patients met inclusion criteria, of which 4,512 developed AF. Non-Hispanic white AUC = 0.673 (95% CI 0.652 to 0.694), African-American AUC = 0.706 (95% CI 0.685 to 0.727), and Hispanic AUC = 0.711 (95% CI 0.691 to 0.732). Calibration analysis showed qualitative similarities between cohorts. In conclusion, this is the first study to validate both the Framingham Heart Study and CHARGE-AF risk scores in both a Hispanic and African-American cohort. All models predicted AF well across all race and ethnic cohorts.
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Eric
authors.initials: E
authors.lastname: Shulman
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Faraj
authors.initials: F
authors.lastname: Kargoli
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Philip
authors.initials: P
authors.lastname: Aagaard
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Ethan
authors.initials: E
authors.lastname: Hoch
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Luigi
authors.initials: L
authors.lastname: Di Biase
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: John
authors.initials: J
authors.lastname: Fisher
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Jay
authors.initials: J
authors.lastname: Gross
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Soo
authors.initials: S
authors.lastname: Kim
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York.
authors.forename: Andrew
authors.initials: A
authors.lastname: Krumerman
authors.affiliation: Division of Cardiology, Department of Medicine, Montefiore Medical Center, Bronx, New York. Electronic address: kferrick@montefiore.org.
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Ferrick
mesh_terms: D001741:Black or African American; D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000208:ethnology*; D004562:Electrocardiography; D005260:Female; D006630:Hispanic or Latino; D006801:Humans; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D014481:United States / Q000453:epidemiology; D044465:White People