Abstract
Lifestyle risk factors (RFs) are a modifiable target in atrial fibrillation (AF) management. The relative contribution of individual lifestyle RFs to the development of AF has not been described. To develop and validate an AF-lifestyle risk score to identify people at risk of AF in the general population. The UK Biobank is a large prospective cohort with outcomes measured >10 years. Incident AF was based on ICD-10 coding. Prior AF was excluded. Regression analysis identified independent predictors of AF, which were evaluated in a multivariable model. A weighted score was developed in the derivation cohort (70% study population) and evaluated in the validation cohort (remaining 30%). Kaplan-Meier estimates ascertained the 10-year risk of AF. The UK Biobank is a large prospective cohort with outcomes measured >10 years. Incident AF was based on ICD-10 coding. Prior AF was excluded. Regression analysis identified independent predictors of AF, which were evaluated in a multivariable model. A weighted score was developed in the derivation cohort (70% study population) and evaluated in the validation cohort (remaining 30%). Kaplan-Meier estimates ascertained the 10-year risk of AF.Among 302,926 participants, AF was diagnosed in 16,029 (5.3%) with median time to AF 7.3 years (IQR 4.3-9.8). Hypertension, sleep apnoea, male sex, age, obesity (BMI>30kg/m2), alcohol and smoking were predictive variables (all p<0.001); physical inactivity (OR 1.036, 95%CI 0.97-1.10, p=0.3), diabetes (OR 1.045, 95%CI 0.97-1.12, p=0.2) and overweight (BMI 27-30kg/m2, OR 1.02, 95%CI 0.971-1.071, p=0.424) were not significant. The weighted HARMS2-AF score (scale 0-14 points, figure 1, top) had similar predictive performance (AUC=0.782 (LogLoss 0.178, Brier Score 0.046) to the unweighted regression model (AUC 0.808). A higher HARMS2-AF score (HARMS-AF score ≥5) was associated with a significantly higher 10-year risk of AF development (score 5-9: OR 9.35, score 10-14: OR 33.34). The HARMS2-AF score is a novel lifestyle risk score which may assist in screening for AF in the general population however further validation studies are required.
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