Risk Factor For Incident Atrial Fibrillation Research Articles

Accelerated Biological Aging and Risk of Atrial Fibrillation: A Cohort Study

BackgroundEven though aging has been demonstrated to be associated with a higher risk of atrial fibrillation (AF). It is unclear whether biological aging is associated with risk of incident AF. ObjectiveThis study aims to investigate the association between biological aging and AF. MethodsA total of 371,882 participants without AF at baseline from the UK Biobank were included. The incident AF was ascertained through linkage to the UK National Health Services register. Biological age was evaluated from clinical traits using the Klemera-Doubal method Biological Age (KDM-BA) and PhenoAge algorithm, respectively. The residual discrepancies between biological age with chronological age were defined as the age accelerations (KDM-BA acceleration and PhenoAge acceleration). The Cox proportional hazards model was used to evaluate the effects of age accelerations with the risk of incident AF. ResultsDuring a mean follow-up of 13.04 years, a total of 28,076 new cases of AF were identified. Accelerated biological age was associated with an increased risk of AF, with a hazard ratio (HR) of 1.11 (95% confidence intervals [CIs] 1.10 - 1.13) per standard deviations (SD) increase in KDM-BA acceleration (10.9 years), and 1.28 (95%CI 1.27 - 1.30) in PhenoAge acceleration (5.6 years), respectively. ConclusionAccelerated biological age quantified by clinical biomarkers is associated with increased risks of AF. Biological aging may represent a potential risk factor for incident AF in midlife and older adults and a potential target for risk assessment and intervention.

Risk calculator for incident atrial fibrillation across a range of prediction horizons

The increasing burden of atrial fibrillation (AF) emphasizes the need to identify high-risk individuals for enrolment in clinical trials of AF screening and primary prevention. We aimed to develop prediction models to identify individuals at high-risk of AF across prediction horizons from 6-months to 10-years. We used secondary-care linked primary care electronic health record data from individuals aged ≥30 years without known AF in the UK Clinical Practice Research Datalink-GOLD dataset between January 2, 1998 and November 30, 2018; randomly divided into derivation (80%) and validation (20%) datasets. Models were derived using logistic regression from known AF risk factors for incident AF in prediction periods of 6 months, 1-year, 2-years, 5-years, and 10-years. Performance was evaluated using in the validation dataset with bootstrap validation with 200 samples, and compared against the CHA2DS2-VASc and C2HEST scores. Of 2,081,139 individuals in the cohort (1,664,911 in the development dataset, 416,228 in the validation dataset), the mean age was 49.9 (SD 15.4), 50.7% were women, and 86.7% were white. New cases of AF were 7,386 (0.4%) within 6 months, 15,349 (0.7%) in 1 year, 38,487 (1.8%) in 5 years, and 79,997 (3.8%) by 10 years. Valvular heart disease and heart failure were the strongest predictors, and association of hypertension with AF increased at longer prediction horizons. The optimal risk models incorporated age, sex, ethnicity, and 8 comorbidities. The models demonstrated good-to-excellent discrimination and strong calibration across prediction horizons (AUROC, 95%CI, calibration slope: 6-months, 0.803, 0.789-0.821, 0.952; 1-year, 0.807, 0.794-0.819, 0.962; 2-years, 0.815, 0.807-0.823, 0.973; 5-years, 0.807, 0.803-0.812, 1.000; 10-years 0.780, 0.777-0.784, 1.010), and superior to the CHA2DS2-VASc and C2HEST scores. The models are available as a web-based FIND-AF calculator. The FIND-AF models demonstrate high discrimination and calibration across short- and long-term prediction horizons in 2 million individuals. Their utility to inform trial enrolment and clinical decisions for AF screening and primary prevention requires further study.

Sleep apnea independently predicts incident atrial fibrillation in the young - Implications for targeted screening

Abstract Background The risk factors predisposing to AF and ischemic stroke are not well defined in the younger population. That said, routine screening for neither obstructive sleep apnea (OSA) nor atrial fibrillation (AF) is recommended, although these risk factors comigrate. We hypothesized that OSA independently predicts AF in the young. Methods We mined electronic data from 2008 to 2022 from a large suburban academic and community healthcare system, for the endpoint of incident AF in 20-50Y adults. We related the endpoint to covariates including CHADSVASC components, OSA, race and socioeconomic factors prior to the diagnosis of AF, excluding patients with existing (prevalent) AF, hemorrhagic stroke, hypercoagulability and central sleep apnea. Results From an overall population of 1.7MM, we identified 765,645 aged 20-50Y. Of these, 7500 had OSA. In the follow-up period, 4833 young individuals (45 per 100K person-years) experienced incident AF. Sleep apnea [HR:5.16; (4.68, 5.68)] was the non-CHADSVASC strongest risk factor for incident AF, other than CKD [HR:3.74 (3.20,4.38)], Black race [HR:1.30 (1.16,1.46)], Hispanic ethnicity [HR:1.20; (1.10, 1.32)] and smoking [HR:1.32; (1.24, 1.41)] (Figure 1A). Within CHADSVASC, other than heart failure [HR:10.23; (8.94,11.80)], all the other components had lower hazards than sleep apnea (Figure 1B). The C-index of CHADSVASC score is 0.51 which is augmented to 0.65 (P<0.05) with addition of OSA, CKD, race, ethnicity and smoking. Conclusions In a population of over 700 thousand 20–50-year-old adults, sleep apnea is a strong independent predictor for incident AF. This has implications for screening and therapy of young patients.

Kidney Function, Albuminuria, and Risk of Incident Atrial Fibrillation: A Systematic Review and Meta-Analysis

Atrial fibrillation (AF) and chronic kidney disease (CKD) often coexist. However, it is not known whether CKD is an independent risk factor for incident AF. Therefore, we evaluated the association between markers of CKD-estimated glomerular filtration rate (eGFR) and albuminuria-and incident AF. Systematic review and meta-analysis of cohort studies and randomized controlled trials. Participants with measurement of eGFR and/or albuminuria who were not receiving dialysis. Cohort studies and randomized controlled trials were included that reported incident AF risk in adults according to eGFR and/or albuminuria. Age- or multivariate-adjusted risk ratios (RRs) for incident AF were extracted from cohort studies, and RRs for each trial were derived from event data. RRs for incident AF were pooled using random-effects models. 38 studies involving 28,470,249 participants with 530,041 incident AF cases were included. Adjusted risk of incident AF was greater among participants with lower eGFR than those with higher eGFR (eGFR<60 vs≥60mL/min/1.73m2: RR, 1.43; 95% CI, 1.30-1.57; and eGFR<90 vs≥90mL/min/1.73m2: RR, 1.42; 95% CI, 1.26-1.60). Adjusted incident AF risk was greater among participants with albuminuria (any albuminuria vs no albuminuria: RR, 1.43; 95% CI, 1.25-1.63; and moderately to severely increased albuminuria vs normal to mildly increased albuminuria: RR, 1.64; 95% CI, 1.31-2.06). Subgroup analyses showed an exposure-dependent association between CKD and incident AF, with the risk increasing progressively at lower eGFR and higher albuminuria categories. Lack of patient-level data, interaction between eGFR and albuminuria could not be evaluated, possible ascertainment bias due to variation in the methods of AF detection. Lower eGFR and greater albuminuria were independently associated with increased risk of incident AF. CKD should be regarded as an independent risk factor for incident AF. Irregular heartbeat, or atrial fibrillation (AF), is the commonest abnormal heart rhythm. AF occurs commonly in people with chronic kidney disease (CKD), and CKD is also common in people with AF. However, CKD in not widely recognized as a risk factor for new-onset or incident AF. In this research, we combined data on more than 28 million participants in 38 studies to determine whether CKD itself increases the chances of incident AF. We found that both commonly used markers of kidney disease (estimated glomerular filtration rate and albuminuria, ie, protein in the urine) were independently associated with a greater risk of incident AF. This finding suggests that CKD should be recognized as an independent risk factor for incident AF.

Risk Factors for Atrial Arrhythmias in Adults With Ebstein Anomaly

BackgroundAtrial arrhythmias (AA) are common in Ebstein anomaly (EA), but risk factors associated with AA are not well understood. ObjectivesThe purpose of this study was to determine the prevalence and risk factors for AA at baseline, incidence, and risk factors for AA during follow-up. MethodsAdults with EA receiving care at Mayo Clinic, MN, between 2003 and 2020 were included. AA was defined as atrial fibrillation (AF) or atrial flutter/tachycardia (AFL). Clinical, echocardiographic, rhythm, surgical data were collected. ResultsOf 682 patients (aged 36 [24-49] years), 235 (34%) had AA at baseline (126 [18%] AF and 144 [21%] AFL), and the risk factors for AA were age, left and right atrial volume indexes, and reservoir strain. Among 447 patients without AA, 10-year cumulative incidence of AF and AFL was 16% and 22%, respectively. The risk factors for incident AF were older age and right atrial reservoir strain. The risk factors for incident AFL were atrial septal defect, left atrial volume index, and male sex. Among patients with baseline AA, 129 (40%) had recurrent episodes (AF 63 [20%], AFL 78 [24%]). The 5-year recurrence rate of AA was 34%, without significant difference for AF vs AFL (46% vs 27%, P = 0.081). Older age and right atrial reservoir strain were associated with recurrent AF. ConclusionsPatients with EA are at risk for incident and recurrent AA. AF was almost as common as AFL despite relatively young ages. Echocardiographic indexes of atrial function can identify at-risk patients, hence be used to improve risk stratification and guide therapy.

Abstract 12955: Clonal Hematopoiesis of Indeterminate Potential: A Novel Risk Factor for Atrial Fibrillation in the UK Biobank Cohort

Introduction: The prevalence of atrial fibrillation (AF) increases with age and inflammation plays a key pathophysiologic role. Somatic mosaicism increases with age and promotes inflammation. Therefore, we investigated whether Clonal Hematopoiesis of Indeterminate Potential (CHIP) is a risk factor for incident AF. Methods: We assessed exome sequence (ES) data from 200,628 participants in the UK biobank. Using the Genome Analysis Toolkit pipeline, we ascertained a predefined list of CHIP mutations in DNMT3A , TET2 , and ASXL1 . CHIP was defined as variant allele frequency (VAF) &gt;10% and those with VAF &lt;2% served as controls. AF was ascertained based on self-report and ICD codes. Lone AF was defined as AF in the absence of heart failure, mitral stenosis, mitral valve repair/valvotomy/replacement, and congenital heart disease. Those with AF prior to or at the time of enrollment were excluded from analyses to ascertain incident events. Cox proportional hazard models adjusted for age, sex, self-reported race/ethnicity, diabetes, hypertension, smoking, and obesity were used to identify associations between CHIP and incident AF. Results: Of 200,628 participants, 3885 (1.9%) had CHIP. The number of participants with mutations in DNMT3A , TET2 , and ASXL1 was 2512, 1065, and 439, respectively. During a median follow-up of 9 years, 4,676 incident AF and 3,584 incident lone AF occurred. CHIP was an independent risk factor for developing incident AF and also for developing lone AF. CHIP in TET2 and ASXL1 but not DNMT3A was associated with AF ( Table 1 ). Conclusions: The presence of CHIP involving TET2 and ASXL1 is associated with an increased risk of incident AF including the subset with lone AF. Our findings reveal somatic mosaicism in blood cells to be a novel risk factor for AF.

Risk of Atrial Fibrillation According to Cancer Type: A Nationwide Population-Based Study

BackgroundPatients with cancer have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the association between cancer type and risk of AF. ObjectivesThis study sought to evaluate the risk of AF according to the type of cancer. MethodsWe enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2016. Age- and sex-matched noncancer control subjects (1:2; n = 1,633,663) were also selected. Newly diagnosed AF was identified based on the type of cancer. ResultsDuring a median follow-up of 4.5 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1,000 person-years). In multivariable Fine and Gray’s regression analysis, cancer was an independent risk factor for incident AF (adjusted subdistribution hazard ratio [aHR]: 1.63; 95% confidence interval [CI]: 1.61 to 1.66). Multiple myeloma showed a higher association with incident AF (aHR: 3.34; 95% CI: 2.98 to 3.75). Esophageal cancer showed the highest risk among solid cancers (aHR: 2.69; 95% CI: 2.45 to 2.95), and stomach cancer showed the lowest association with AF risk (aHR: 1.27; 95% CI 1.23 to 1.32). ConclusionsAlthough patients with cancer were found to have a higher risk of AF, the impact on AF development varied by cancer type.

Refining age stratum of the C2HEST score for predicting incident atrial fibrillation in a hospital-based Chinese population

BackgroundThe C2HEST score (C2: coronary artery disease [CAD] / chronic obstructive pulmonary disease [COPD] (1 point each); H: Hypertension; E: Elderly (Age≥75, doubled); S: Systolic heart failure (doubled); T: Thyroid disease (hyperthyroidism)) has been validated to predict incident atrial fibrillation (AF). Its performance in the hospital-based Chinese population has never been evaluated. MethodsRisk factors for incident AF were investigated in a hospital-based population. Comparison of the C2HEST score and other clinical scores with the capacity of predicting incident AF was conducted using area under the curves (AUC), net reclassification index (NRI), integrated discriminative improvement (IDI), and decision curve analysis (DCA). An age-stratified criterion was used to refine the C2HEST score to form a modified C2HEST score (mC2HEST). The performance of the mC2HEST score was also evaluated. ResultsA total of 23,523 patients entered the study with 520 developed AF during 2.84 ± 3.56 years of follow-up. Risk factors for incident AF included age, male sex, hypertension, CAD, COPD, previous ischemic stroke, hyperthyroidism, and heart failure. Age ≥65 years has significantly increased the risk of AF, which was considered as the age cutoff for a modified C2HEST score (mC2HEST). The risk of AF increased by 89% per one-point increase of the mC2HEST score. The mC2HEST score showed better predictive performance (AUC of 0.809) compared with the original C2HEST (AUC of 0.752), CHA2DS2-VASc (0.756), HATCH (0.722), and HAVOC (0.758) scores, also as estimated by IDI, NRI and DCA. Among those enrolled after 2012, the mC2HEST score had numerically higher AUC (0.849) compared with the C2HEST score (0.826) and the other scores. ConclusionIn a hospital-based Chinese population, by refining the age strata of the original C2HEST score, the mC2HEST score had significantly increased predictive accuracy and discriminative capability for incident AF. The clinical benefits of the application of novel mC2HEST score needs further validation in multiple settings.

Incidence of atrial fibrillation in an opportunistic screening campaign in a general practitioner setting: a prospective population study

Abstract Introduction The detection of atrial fibrillation (AF) largely depends on the method used, thus the reported true rate of incident AF is controversial. The detection of symptomatic AF is straight forward in most cases, while it is unclear which strategies provide the best results for the detection of silent AF. Traditional methods like pulse palpation have a low accuracy and pulse guided ECG confirmation is not deemed cost-effective. Purpose The aim of the study was to detect the incidence symptomatic AF, using ECG, and opportunistic screening of silent AF, using an AF-detection capable automatic sphygmomanometer, in patients ≥65 years old in the general practitioner (GP) setting. Methods This was a population-based prospective cohort study of unselected general population referred for routine visits in 93 randomly selected GPs. Patients of both sexes of ≥65 years without previous diagnosis of AF were considered for the study. Each patient if symptomatic was directly referred to perform an ECG, otherwise if asymptomatic, underwent blood pressure monitoring with an AF-detection capable automatic sphygmomanometer followed by an ECG in case the device signaled AF. Results The final population comprised of 14987 individuals of ≥65 years old. The follow up extended to 16838 patient-years. The overall incidence of AF was 2.25% patient-years (95% CI 2.03–2.48). AF incidence was significantly higher in male (male/female ratio 1.29), overweight (BMI: 28.2 kg/m2 vs 27.0 kg/m2), older (79.1 vs 75.4 years old) individuals, with 44.9% belonging to the ≥80-year-old group. Other risk factors for incident AF were higher systolic BP measurements, history of stroke/TIA, congestive heart failure and chronic kidney disease. On multivariate analysis, age (annual increment), mitral valve disease, previous stroke and the number of annual visits (&amp;gt;10), were independent predictors of incidental AF. About 25% of cases were silent AF (0.56% patient-years, 95% CI 0.46–0.69) and were identified using the AF-detection capable automatic sphygmomanometer. Independent predictors of silent AF were age (per year increment), overweight (BMI &amp;gt;28 kg/m2) and the number of visits (&amp;gt;10) in the GPs' office. Conclusions We found a higher than previously reported incidence of AF possibly due to capturing silent AF. This simple protocol, using an AF-capable automatic sphygmomanometer, might be feasible and easily implemented on the routine GP care where high rates of coverage can be achieved. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Veneto Region Italy

Different risk of atrial fibrillation according to the type of cancer: a nationwide population-based study

Abstract Introduction Patients with malignancies are known to have an increased risk of atrial fibrillation (AF). However, there is a paucity of information regarding the cancer type and the risk of AF. We aimed to evaluate the risk of AF according to the type of cancer. Methods We enrolled 816,811 patients who were diagnosed with cancer from the Korean National Health Insurance Service database between 2009 and 2014. Age and sex-matched non-cancer control subjects (1:2, n=1,633,663) were selected and compared with patients with malignancy. Newly diagnosed nonvalvular AF was identified using the claims data. Besides, we performed a sensitivity analysis using lag periods from cancer diagnosis to AF for more than 1 year and more than 5 year. Results During a mean follow up of 4.7 years, AF was newly diagnosed in 25,356 patients with cancer (6.6 per 1000 person-years) whereas 31,801 patients in the control group (3.6 per 1000 person-years). In multivariate Cox regression analysis, cancer was an independent risk factor for incident AF (HR 1.97; 95% CI 1.94–2.00). Hematologic malignancies show higher correlation with incident AF (multiple myeloma, the hazard ratio (HR) 4.57; 95% confidence interval (CI) 4.08–5.12; leukemia, HR 4.15; 95% CI 3.75–4.59). Malignancies of the nervous system, esophagus, lung, and pancreatic cancer show higher risks of AF more than 3 times than control, whereas prostate cancer shows the lowest association with AF risk (HR 1.36; 95% CI 1.29–1.44). In subgroup analysis, the effect of cancer on AF development was more prominent in patients with younger age (&amp;lt;65 years) and fewer comorbidities (hypertension, diabetes mellitus, chronic kidney disease, dyslipidemia, and obesity). In sensitivity analysis using lag periods, the strength of risks of AF decline with time from cancer diagnosis but remain significant (“&amp;gt;1yr” HR 1.77; 95% CI 1.74–1.81; “&amp;gt;5yrs” HR 1.12; 95% CI 1.07–1.16). However, AF risk was more diverse according to the types of cancers in patients surviving above five years. Multiple myeloma, leukemia, lymphoma, ovarian, liver, and lung cancer show higher risks of AF than control while other types of cancer show no significant association with AF incidence after five years from a cancer diagnosis. Conclusion Although patients with cancer showed a higher risk of AF, but the impact on AF development was diverse among cancer types. Hematologic malignancies showed the highest risk of AF, and the risk was maintained up to 5 year after diagnosis of cancer. Therefore it would be reasonable to screen AF especially in those malignancies with high-risk for AF. Different AF risk in cancer patients Funding Acknowledgement Type of funding source: None

Atrial fibrillation is associated with central sleep apnea in clinic patients undergoing diagnostic polysomnography.

IntroductionSleep apnea is highly prevalent in patients with atrial fibrillation (AF). Obstructive sleep apnea (OSA) is the most common type, and best studied in the context of AF. However, recent investigations have indicated that central sleep apnea (CSA) may be a risk factor for incident AF. We evaluated the burden of CSA events in patients referred for diagnostic polysomnography (PSG) and whether AF is associated with CSA.MethodsWe identified patients with and without a history of AF who underwent clinically indicated PSG in a matched manner. OSA was defined as obstructive apnea‐hypopnea index (AHI) ≥15/h, and CSA was defined as central apnea index (CAI) ≥5/h. The association between AF and CSA was evaluated using multivariable logistic regression.ResultsAmong 465 patients included, mean AHI was 25.5/h, and mean CAI was 1.7/h. OSA prevalence was 53.3%, while CSA prevalence was 8.4%. The prevalence of OSA in the AF and non‐AF groups (54.7% vs 52.0%, P = .56) was similar. CSA was more common in the AF group (12.3% vs 4.4%, P = .002). In multivariable analysis, AF (OR: 2.19 [1.02, 5.03], P = .05), male gender (OR: 2.5 [1.17, 5.84], P = .02), and older age (OR: 2.44, [1.16, 5.46], P = .02) were associated with CSA.ConclusionThough CSA is much less common than OSA in patients with AF, the presence of AF is independently associated with CSA.

Association of overlap syndrome with incident atrial fibrillation

Increasingly compelling data link chronic obstructive pulmonary disease (COPD) and obstructive sleep apnea (OSA) to cardiovascular complications independent of known comorbidities. It remains unclear whether the association is amplified in the presence of both conditions. The aims of this study are to assess the prevalence of atrial fibrillation (AF) in overlap syndrome (OS) and to identify risk factors predisposing to this atrial arrhythmia. We conducted a retrospective cohort study of 268 adults without past or current AF who were referred for an initial diagnostic polysomnogram from 2012 to 2019. A logistic regression analysis was performed to identify risk factors for incident AF. Incident AF occurred in 64 subjects [cumulative probability 24%, 95% confidence interval (CI) 19-29]. Independent predictors of incident AF were age-adjusted Charlson index [Odds ratio (OR) 1.62; 95% confidence interval (CI) 1.3-2.0], percentage of time spent with O2 saturation below 90% (CT90) (OR 3.72, 95% CI 1.18-11.71), and CPAP adherence (OR 0.32, 95% CI 0.13-0.71). OS patients with AF experienced higher hospitalization rates (OR 1.25, 95% CI 1.03-2.37) and worse mortality rates (OR 1.92, 95% CI 1.04-3.54). In multivariate Cox proportional regression, age-adjusted Charlson Index, severity of airflow obstruction, and CPAP adherence were independent predictors of mortality. The burden of hypoxemia and severity of comorbidities are independent factors for incident AF in individuals with OS. CPAP adherence may mitigate the risk of AF and reduce the rate of mortality in this population.

Ablación de la fibrilación auricular en pacientes con insuficiencia cardiaca: el control del ritmo sí importa

Heart failure (HF) and atrial fibrillation (AF) are highly prevalent pathologies, associated with an increased morbidity, mortality and hospital readmissions. Both pathologies are closely interrelated, so that HF constitutes a risk factor for incident AF, and vice versa, and they coexist in up to 30% of patients. Treatment options for AF in HF patients vary widely. Although medical treatment has been the most accepted approach, sometimes it fails to reach appropriate management and has limited prognostic impact. In recent randomized studies, AF ablation has shown to be superior to medical treatment with improved AF burden and mortality. In this article, the evidence supporting ablation as a valid strategy to treat AF in patients with HF is reviewed.

P5667A clinical risk score for predicting incident atrial fibrillation in Asians: derivation in 7,220,654 Taiwan subjects with 438,930 incident atrial fibrillation

Abstract Background The patient number of atrial fibrillation (AF) is continuously increasing all over the world. No risk score for predicting incident AF has been specifically developed using a nationwide dataset for Asians. Our aim was to investigate risk factors for incident AF in Asians and to combine them to develop a clinical risk scheme. Method From January 1st 2000 to December 31st 2000, 7,220,654 subjects aged &gt;40 years without past history of cardiac arrhythmia were identified from the Taiwan National Health Insurance Research Database. Cox regression analysis was performed to identify significant clinical predictors of incident AF which were then incorporated together to develop a scoring scheme. Results During a follow up of 16 years, 438,930 patients experienced incident AF. The significant predictors and the calculation rule of the scoring scheme are shown in Figure A. The score ranged from −3 to 25, and the risk of incident AF ranged from 0.06%/year for patients with a score −3 to 7.99%/year for those with a score &gt;19. The AUC in the prediction of 1-year risk of incident AF was 0.86 and was 0.75 for 16-year risk of AF (Figure B), which was higher than that of CHADS2, CHA2DS2-VASc and C2HEST scores. Conclusion A clinical risk score has been developed based on a large nationwide database which could be used to identify patients at a high risk of incident AF.

Revisiting the risks of incident atrial fibrillation: a narrative review. Part 1.

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Much focus has been directed towards AF prevention, given the morbidity, mortality, and financial cost to health care systems associated with this arrhythmia. There are a number of common conditions associated with the onset of AF, but not only limited to hypertension, diabetes, or smoking. As we understand the factors associated with incident AF, public health campaigns and targeted patient interventions are warranted to promote blood pressure control, glycemic control in patients with diabetes, smoking cessation to prevent AF, and associated comorbidity. In this narrative review, we consider some of the evidence linking these risk factors with AF. We additionally examine the role of risk factor modification in reducing AF burden. In Part 1 we address the evidence for hypertension, diabetes, and smoking as risk factors for incident AF.

Risk factors for the development of atrial fibrillation on ibrutinib treatment

Ibrutinib increases the risk of atrial fibrillation (AF), but the associated risk factors are not clearly defined. We performed retrospective review of ibrutinib-treated patients in a large academic practice to identify risk factors for new-onset AF. Variables with p-values <.05 in logrank analysis were included as pairs in two-variable Cox regression. Of the 168 patients treated with ibrutinib, 60.7% had chronic lymphocytic leukemia/small lymphocytic lymphoma and 39.3% other histologies. The incidence of AF was 11.9% after a median 154-day ibrutinib exposure. Only heart failure (hazard ratio, 95% confidence interval; 14.1, 5.3–37.2) and left atrial abnormality on electrocardiogram (5.4, 1.9–15.4) were independently significant in paired Cox regression. Eighty-seven percent of patients with HF satisfied Framingham clinical criteria. As structural heart disease is a strong risk factor for incident AF, we emphasize the importance of baseline electrocardiogram, recommend baseline clinical screening for HF and, in specific instances, a baseline echocardiogram.

Relative contribution of modifiable risk factors for incident atrial fibrillation in Hispanics, African Americans and non-Hispanic Whites

BackgroundContribution of modifiable risk factors for the risk of new onset atrial fibrillation (AF) in minority populations is poorly understood. Our objective was to compare the population attributable risk (PAR) of various risk factors for incident AF between Hispanic, African American and non-Hispanic Whites. MethodsAn ECG/EMR database was interrogated for individuals free of AF for development of subsequent AF from 2000 to 2013. Cox regression analysis controlled for age > 65, male gender, body mass index > 40 kg/m2, systolic blood pressure > 140 mm Hg, diabetes mellitus, heart failure, socioeconomic status less than the first percentile in New York State, and race/ethnicity. PAR was calculated as (prevalence of X) ∗ (HR − 1)/HR, where HR is the hazard ratio, and X is the risk factor. Results47,722 persons free of AF (43% Hispanic, 37% Black and 20% White) were followed for subsequent incident AF. Hypertension in African Americans and Hispanics had a 7.93% and 7.66% greater PAR compared with non-Hispanics Whites. Similar findings existed for the presence of heart failure, with a higher PAR in non-Whites compared to Whites. ConclusionIn conclusion, modifiable risk factors play an important role in the risk of incident AF. Higher PAR estimates in African Americans and Hispanics were observed for elevated systolic blood pressure and heart failure. Identification of these modifiable risk factors for atrial fibrillation in non-White minorities may assist in targeting better prevention therapies and planning from a public health perspective. No funding sources were used for this study.

A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects

The incidence of atrial fibrillation (AF) is increasing, conferring a major health-care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects and to combine them into a simple clinical risk score. Risk factors for incident AF were analyzed in 471,446 subjects from the Chinese Yunnan Insurance Database (internal derivation cohort) and then combined into a simple clinical risk score. External application of the new score was performed in 451,199 subjects from the Korean National Health Insurance Service (external cohort). In the internal cohort, structural heart disease (SHD), heart failure (HF), age≥ 75 years, coronary artery disease (CAD), hyperthyroidism, COPD, and hypertension were associated with incident AF. Given the low prevalence and the strong association of SHD with incident AF (hazard ratio, 26.07; 95%CI, 18.22-37.30; P< .001), these patients should be independently considered as high risk for AF and were excluded from the analysis. The remaining predictors were combined into the new simple C2HEST score: C2: CAD/COPD (1 point each); H: hypertension (1 point); E: elderly (age≥ 75 years, 2 points); S: systolic HF (2 points); and T: thyroid disease (hyperthyroidism, 1 point). The C2HEST score showed good discrimination with the area under the curve (AUC) of 0.75 (95%CI, 0.73-0.77) and had good calibration (P= .774). The score was internally validated by bootstrap sampling procedure, giving an AUC of 0.75 (95%CI, 0.73-0.77). External application gave an AUC of 0.65 (95%CI, 0.65-0.66). The C2HEST score was superior to CHADS2 and CHA2DS2-VASc scores in both cohorts in predicting incident AF. We have developed and validated the C2HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD.

Increasing population height and risk of incident atrial fibrillation: the Copenhagen City Heart Study.

The incidence of atrial fibrillation (AF) has increased significantly over the last decades. Population height is changing in many countries. Height is an important risk factor for AF. The aim of the present study was to assess the role of changes in population height in the increased risk of AF. The Copenhagen City Heart Study comprises 18852 randomly selected men and women aged 20-93 years, studied in four separate cross-sectional surveys in 1976-78, 1981-83, 1991-94, and 2001-03, including physical examination, electrocardiogram (ECG), and standard questionnaires. Hospitalization and mortality data were collected from public registers. Prevalent AF was determined from ECGs and incident AF from register diagnoses. During follow-up, age-standardized prevalence of AF increased significantly from 1.35% to 2.11% in men and from 0.67% to 1.07% in women (P < 0.001). Incident AF increased four-fold in both men and women [hazard ratio (HR) 4.16, 95% confidence interval (CI) 3.27-5.29; P < 0.001]. In multivariable Fine and Gray subdistribution hazards regression analyses, height was consistently an important risk factor for incident AF with HRs between 1.35 (95% CI 1.10-1.66; P = 0.004) and 1.65 (95% CI 1.40-1.93; P < 0.001). Population height increased with 3.3 cm for men and 2.1 cm for women, and population attributable risks for height was 20-30%. Height is a powerful risk factor for AF. Adult height is attained at age 20, while AF incidence occurs 50 years later. Given a causal relationship between height and AF incidence, increased population height in Denmark will contribute to an increase in AF occurrence for at least 25 more years.

Electrocardiogram (ECG) for the Prediction of Incident Atrial Fibrillation: An Overview.

Electrocardiograms (ECGs) have been employed to medically evaluate participants in population-based studies, and ECG-derived predictors have been reported for incident atrial fibrillation (AF). Here, we reviewed the status of ECG in predicting new-onset AF. We surveyed population-based studies and revealed ECG variables to be risk factors for incident AF. When available, the predictive values of each ECG risk marker were calculated. Both the atrium-related and ventricle-related ECG variables were risk factors for incident AF, with significant hazard risks (HRs) even after multivariate adjustments. The risk factors included P-wave indices (maximum P-wave duration, its dispersion or variation and P-wave morphology) and premature atrial contractions (PACs) or runs. In addition, left ventricular hypertrophy (LVH), ST-T abnormalities, intraventricular conduction delay, QTc interval and premature ventricular contractions (PVCs) or runs were a risk of incident AF. An HR of greater than 2.0 was observed in the upper 5th percentile of the P-wave durations, P-wave durations greater than 130 ms, P-wave morpholyg, PACs (PVCs) or runs, LVH, QTc and left anterior fascicular blocks. The sensitivity , specificity and the positive and negative predictive values were 3.6-53.8%, 61.7-97.9%, 2.9-61.7% and 77.4-97.7%, respectively. ECG variables are risk factors for incident AF. The correlation between the ECG-derived AF predictors, especially P-wave indices, and underlying diseases and the effects of the reversal of the ECG-derived predictors on incident AF by treatment of comorbidities require further study.