Risk assessment for incident heart failure in individuals with atrial fibrillation

Renate B. Schnabel, Michiel Rienstra, Lisa M. Sullivan, Jenny X. Sun, Carlee B. Moser, Daniel Levy, Michael J. Pencina, Joao Daniel T. Fontes, Jared W. Magnani, David D. McManus, Steven A. Lubitz, Thomas M. Tadros, Thomas J. Wang, Patrick T. Ellinor, Ramachandran S. Vasan, Emelia J. Benjamin

Research output: Contribution to journalArticle

38 Citations (Scopus)

Abstract

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 χ2 statistic 7.29; Pχ2 = 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. Conclusion: sWe 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.

Original languageEnglish (US)
Pages (from-to)843-849
Number of pages7
JournalEuropean Journal of Heart Failure
Volume15
Issue number8
DOIs
StatePublished - Aug 2013
Externally publishedYes

Fingerprint

Atrial Fibrillation
Heart Failure
Hypertrophy
Calibration
Body Mass Index
Myocardial Infarction
Heart Murmurs
Incidence
Electrocardiography
Confidence Intervals
Morbidity
Mortality

Keywords

  • Atrial fibrillation
  • Epidemiology
  • Heart failure
  • Risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Schnabel, R. B., Rienstra, M., Sullivan, L. M., Sun, J. X., Moser, C. B., Levy, D., ... Benjamin, E. J. (2013). Risk assessment for incident heart failure in individuals with atrial fibrillation. European Journal of Heart Failure, 15(8), 843-849. https://doi.org/10.1093/eurjhf/hft041

Risk assessment for incident heart failure in individuals with atrial fibrillation. / Schnabel, Renate B.; Rienstra, Michiel; Sullivan, Lisa M.; Sun, Jenny X.; Moser, Carlee B.; Levy, Daniel; Pencina, Michael J.; Fontes, Joao Daniel T.; Magnani, Jared W.; McManus, David D.; Lubitz, Steven A.; Tadros, Thomas M.; Wang, Thomas J.; Ellinor, Patrick T.; Vasan, Ramachandran S.; Benjamin, Emelia J.

In: European Journal of Heart Failure, Vol. 15, No. 8, 08.2013, p. 843-849.

Research output: Contribution to journalArticle

Schnabel, RB, Rienstra, M, Sullivan, LM, Sun, JX, Moser, CB, Levy, D, Pencina, MJ, Fontes, JDT, Magnani, JW, McManus, DD, Lubitz, SA, Tadros, TM, Wang, TJ, Ellinor, PT, Vasan, RS & Benjamin, EJ 2013, 'Risk assessment for incident heart failure in individuals with atrial fibrillation', European Journal of Heart Failure, vol. 15, no. 8, pp. 843-849. https://doi.org/10.1093/eurjhf/hft041
Schnabel, Renate B. ; Rienstra, Michiel ; Sullivan, Lisa M. ; Sun, Jenny X. ; Moser, Carlee B. ; Levy, Daniel ; Pencina, Michael J. ; Fontes, Joao Daniel T. ; Magnani, Jared W. ; McManus, David D. ; Lubitz, Steven A. ; Tadros, Thomas M. ; Wang, Thomas J. ; Ellinor, Patrick T. ; Vasan, Ramachandran S. ; Benjamin, Emelia J. / Risk assessment for incident heart failure in individuals with atrial fibrillation. In: European Journal of Heart Failure. 2013 ; Vol. 15, No. 8. pp. 843-849.
@article{d0e1e499e828474693f9c3f92fd76696,
title = "Risk assessment for incident heart failure in individuals with atrial fibrillation",
abstract = "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 χ2 statistic 7.29; Pχ2 = 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. Conclusion: sWe 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.",
keywords = "Atrial fibrillation, Epidemiology, Heart failure, Risk score",
author = "Schnabel, {Renate B.} and Michiel Rienstra and Sullivan, {Lisa M.} and Sun, {Jenny X.} and Moser, {Carlee B.} and Daniel Levy and Pencina, {Michael J.} and Fontes, {Joao Daniel T.} and Magnani, {Jared W.} and McManus, {David D.} and Lubitz, {Steven A.} and Tadros, {Thomas M.} and Wang, {Thomas J.} and Ellinor, {Patrick T.} and Vasan, {Ramachandran S.} and Benjamin, {Emelia J.}",
year = "2013",
month = "8",
doi = "10.1093/eurjhf/hft041",
language = "English (US)",
volume = "15",
pages = "843--849",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "8",

}

TY - JOUR

T1 - Risk assessment for incident heart failure in individuals with atrial fibrillation

AU - Schnabel, Renate B.

AU - Rienstra, Michiel

AU - Sullivan, Lisa M.

AU - Sun, Jenny X.

AU - Moser, Carlee B.

AU - Levy, Daniel

AU - Pencina, Michael J.

AU - Fontes, Joao Daniel T.

AU - Magnani, Jared W.

AU - McManus, David D.

AU - Lubitz, Steven A.

AU - Tadros, Thomas M.

AU - Wang, Thomas J.

AU - Ellinor, Patrick T.

AU - Vasan, Ramachandran S.

AU - Benjamin, Emelia J.

PY - 2013/8

Y1 - 2013/8

N2 - 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 χ2 statistic 7.29; Pχ2 = 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. Conclusion: sWe 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.

AB - 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 χ2 statistic 7.29; Pχ2 = 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. Conclusion: sWe 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.

KW - Atrial fibrillation

KW - Epidemiology

KW - Heart failure

KW - Risk score

UR - http://www.scopus.com/inward/record.url?scp=84881010720&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84881010720&partnerID=8YFLogxK

U2 - 10.1093/eurjhf/hft041

DO - 10.1093/eurjhf/hft041

M3 - Article

VL - 15

SP - 843

EP - 849

JO - European Journal of Heart Failure

JF - European Journal of Heart Failure

SN - 1388-9842

IS - 8

ER -