Key result
Multivariable risk models (CHARGE-AF and FHS-AF) showed good discrimination for incident AF (C-statistic 0.83-0.86) but provided limited additional discriminatory value over age alone.
Why the study?
AF screening is often restricted to individuals aged ≥65 years, and it was unknown whether multivariable models add value over age alone to expand screening to younger individuals.
Do multivariable risk models improve the prediction of 5-year and 10-year atrial fibrillation risk compared to age alone in a young community cohort?
Cohort (n=8,265)
Do multivariable risk models improve the prediction of 5-year and 10-year atrial fibrillation risk compared to age alone in a young community cohort?
Effect estimate: C-statistic 0.83-0.86
Multivariable risk models for atrial fibrillation do not provide substantial additional discriminatory value over age alone in young community-dwelling individuals, suggesting that primary AF screening strategies using these models should not be expanded to younger populations.
Limited value of AF models over age in young cohorts; leaves open whether age-based screening improves detection or outcomes.
Background Advancing age is the primary selection criterion for community screening for atrial fibrillation (AF), with selection often restricted to those aged ≥65 years. If multivariable models were shown to have considerable additional value over age alone in predicting AF risk among younger individuals, AF screening could be expanded to patients with lower age, but with high AF risk as per a validated risk model. Methods We validated risk models CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology model for AF) and FHS-AF (Framingham Heart Study model for AF), and risk scores CHA2DS2-VASc and CHA2DS2-VA, and presented their predictive abilities for 5-year and 10-year AF risk versus that of age alone in a young Dutch population cohort (PREVEND) free from AF at baseline. We assessed discrimination by the C-statistic and calibration by the calibration plot and stratified Kaplan-Meier plot using survey-weighted Cox models. Results During 5-year and 10-year follow-up there were n=98 (2.46/1000 person-years) and n=249 (3.29/1000 person-years) new AF cases, respectively, among 8265 participants with mean age 49±13 years. CHARGE-AF and FHS-AF both showed good discrimination for 5-year and 10-year AF (C-statistic range 0.83–0.86) with accurate calibration for 5-year AF, but overestimation of 10-year AF risk in highest-risk individuals. CHA2DS2-VASc and CHA2DS2-VA relatively underperformed. Age alone showed similar discrimination to that of CHARGE-AF and FHS-AF both in the overall, young PREVEND cohort and in subgroups for lower age and lower stroke risk. Conclusion Multivariable models accurately discriminate for 5-year and 10-year AF risk among young European community-dwelling individuals. However, their additional discriminatory value over age alone was limited. Selection strategies for primary AF screening using multivariable models should not be expanded to younger individuals.
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Himmelreich et al. (2022) conducted a cohort in Atrial fibrillation (n=8,265). Multivariable risk models (CHARGE-AF, FHS-AF, CHA2DS2-VASc, CHA2DS2-VA) vs. Age alone was evaluated on 5-year and 10-year incident atrial fibrillation (C-statistic 0.83-0.86). Multivariable risk models (CHARGE-AF and FHS-AF) showed good discrimination for incident AF (C-statistic 0.83-0.86) but provided limited additional discriminatory value over age alone.
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