What is the clinical evidence from this study?

Study design: Cohort. Population: Hypertension (n=12206). Intervention: Risk factor assessment (Age, Sex, BMI, Heart Failure). Primary outcome: Incidence of atrial fibrillation (HR 2.57, 95% CI 1.70-3.90, p=<0.001).

What does this research mean for the field?

Age, male sex, obesity, and heart failure are independent predictors of atrial fibrillation in hypertensive patients, enabling the formulation of a new clinical risk score to identify high-risk individuals. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

March 16, 2020Open Access

A new risk score to assess atrial fibrillation risk in hypertensive patients (ESCARVAL-RISK Project

Q: What are the key findings of this study?

Age, male sex, obesity, and heart failure were identified as independent predictors of atrial fibrillation in hypertensive patients, with grade II obesity conferring the highest risk (HR 2.57).

Q: What does this research mean for the field?

Age, male sex, obesity, and heart failure are independent predictors of atrial fibrillation in hypertensive patients, enabling the formulation of a new clinical risk score to identify high-risk individuals. Novelty: ClaimNovelty.METHODOLOGICAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Resultado clave

Age, male sex, obesity, and heart failure were identified as independent predictors of atrial fibrillation in hypertensive patients, with grade II obesity conferring the highest risk (HR 2.57).

Diseño del estudio

Tipo

Cohort (n=12,206)

Multicéntrico

Sí

PICO estructurado

Población

12,206 patients aged ≥40 years with hypertension, free of atrial fibrillation and with no previous cardiovascular events, recruited in primary healthcare centers. Mean age 64.9 years, 52.6% men.

Resultado

Incidence of atrial fibrillationhard clinical

A new risk score incorporating age, male sex, obesity, and heart failure can identify hypertensive patients at greatest risk for developing incident atrial fibrillation.

Resultado numérico

Estimación del efecto: HR 2.57 (95% CI 1.70-3.90)

valor p: p=<0.001

Limitaciones

Greater chance of AF not being properly recorded in routine clinical practice
Variables like sleep apnea, physical inactivity, and high-intensity exercise were not routinely recorded
Echocardiography was not included in the risk score due to low availability
Derived from a single, predominantly white Mediterranean hypertensive cohort

Resumen

This study aimed to assess atrial fibrillation (AF) incidence and predictive factors in hypertensive patients and to formulate an AF risk assessment score that can be used to identify the patients most likely to develop AF. This was a cohort study of patients recruited in primary healthcare centers. Patients aged 40 years or older with hypertension, free of AF and with no previous cardiovascular events were included. Patients attended annual visits according to clinical practice until the end of study or onset of AF. The association between AF incidence and explanatory variables (age, sex, body mass index, medical history and other) was analyzed. Finally, 12,206 patients were included (52.6% men, and mean age was 64.9 years); the mean follow-up was 36.7 months, and 394 (3.2%) patients were diagnosed with AF. The incidence of AF was 10.5/1000 person-years. Age (hazard ratio HR 1.06 per year; 95% confidence interval CI 1.05-1.08), male sex (HR 1.88; 95% CI 1.53-2.31), obesity (HR 2.57; 95% CI 1.70-3.90), and heart failure (HR 2.44; 95% CI 1.45-4.11) were independent predictors (p < 0.001). We propose a risk score based on significant predictors, which enables the identification of people with hypertension who are at the greatest risk of AF.

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