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, João D. 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

48 Scopus citations

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 1 2013
Externally publishedYes

Keywords

  • Atrial fibrillation
  • Epidemiology
  • Heart failure
  • Risk score

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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  • Cite this

    Schnabel, R. B., Rienstra, M., Sullivan, L. M., Sun, J. X., Moser, C. B., Levy, D., Pencina, M. J., Fontes, J. D., Magnani, J. W., McManus, D. D., Lubitz, S. A., Tadros, T. M., Wang, T. J., Ellinor, P. T., Vasan, R. S., & 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