Key result
Higher recent CHARGE-AF score is associated with increased risk of incident atrial fibrillation.
Why the study?
The utility of repeated CHARGE-AF score assessments for improving atrial fibrillation risk prediction was unclear.
Does the addition of prior, repeated CHARGE-AF scores improve the prediction of incident atrial fibrillation compared to a single recent CHARGE-AF score in an adult cohort?
Cohort (n=10,188)
Yes
Does the addition of prior, repeated CHARGE-AF scores improve the prediction of incident atrial fibrillation compared to a single recent CHARGE-AF score in an adult cohort?
A single, most recent assessment of the CHARGE-AF score provides sufficient predictive value for incident atrial fibrillation, with historical score trajectories offering limited incremental benefit.
Supports single recent CHARGE-AF assessment for AF risk stratification; extends validation by showing limited incremental value from historical scores.
Background: The Cohorts for Heart and Aging Research in Genomic Epidemiology - Atrial Fibrillation (CHARGE-AF) score is a validated tool for estimating 5-year risk of atrial fibrillation (AF). We aimed to evaluate the utility of repeated CHARGE-AF scores for improving AF risk prediction. Methods: We analyzed participants from the Atherosclerosis Risk in Communities (ARIC) study with complete data from the first four clinic visits (9-year period) and with no prevalent AF by visit 4 (analysis baseline; N = 10,188). CHARGE-AF scores were calculated for each visit using clinical and demographic variables. Incident AF was determined from electrocardiograms, hospital discharge codes, and death certificates over a median follow-up of 19.5 years. Four Cox regression models were assessed: model 1 included only the visit 4 CHARGE-AF score, and subsequent models added prior CHARGE-AF scores in stepwise fashion. C-statistics were used to evaluate model discrimination, and comparison of observed versus predicted risk was employed to evaluate calibration. Secondary analysis restricted follow-up to five years. Results: During follow-up, 2,519 participants developed AF (14.2 cases per 1,000 person-years). The mean age of participants at start of follow-up was 62.8 (±5.6) years. In the primary analysis, each 1% increase in the visit 4 CHARGE-AF score was associated with incident AF (Model 1 HR = 1.14, 95% CI 1.13-1.15). Addition of scores from prior visits did not significantly improve model discrimination (C-statistic: 0.702-0.703 for all models). Sex modified the association between a 1% increase in CHARGE-AF score and incident AF, with a stronger association among females (Model 1 HR = 1.21, 95% CI: 1.19-1.22) than among males (HR for model 1 = 1.12, 95% CI: 1.11-1.13). Similar patterns were observed in the secondary (5-year restricted) analysis. Conclusions: A single measurement of the CHARGE-AF score provided strong predictive value for incident AF, with the addition of prior scores offering limited incremental benefit. These findings suggest that, in clinical settings with longitudinal data, the most recent assessment is sufficient for AF risk prediction.
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Villarreal et al. (2026) conducted a cohort in Atrial Fibrillation (n=10,188). CHARGE-AF score (per 1% increase) was evaluated on Incident Atrial Fibrillation (HR 1.14, 95% CI 1.13-1.15). A 1% increase in the most recent CHARGE-AF score increased the risk of incident atrial fibrillation by 14% (HR 1.14), with prior risk scores providing limited incremental predictive value.
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