A comparison of the CHARGE-AF and the CHA₂DS₂-VASc risk scores for prediction of atrial fibrillation in the Framingham Heart Study

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• 作者：Ingrid E. Christophersen ; MD ; PhD^a ; ^b ; ^c ; Xiaoyan Yin ; PhD^d ; ^e ; Martin G. Larson ; SD^d ; ^e ; ^f ; Steven A. Lubitz ; MD ; MPH^a ; ^b ; ^g ; Jared W. Magnani ; MD ; MSc^d ; ^h ; David D. McManus ; MD ; ScMⁱ ; Patrick T. Ellinor ; MD ; PhD^a ; ^b ; ^g ; Emelia J. Benjamin ; MD ; ScM^d ; ^h ; ^j ; ^{emelia@bu.edu" class="auth_mail" title="E-mail the corresponding author}
• 关键词：AF ; Atrial fibrillation ; AGES ; Age Gene/Environment Susceptibility Study ; CHARGE ; Cohorts for Heart and Aging Research in Genomic Epidemiology ; sHR ; Sub-distribution hazard ratio ; FHS ; Framingham Heart Study
• 刊名：American Heart Journal
• 出版年：2016
• 出版时间：August 2016
• 年：2016
• 卷：178
• 期：Complete
• 页码：45-54
• 全文大小：621 K

文摘

Atrial fibrillation (AF) affects more than 33 million individuals worldwide and increases risks of stroke, heart failure, and death. The CHARGE-AF risk score was developed to predict incident AF in three American cohorts and it was validated in two European cohorts. The CHA₂DS₂-VASc risk score was derived to predict risk of stroke, peripheral embolism, and pulmonary embolism in individuals with AF, but it has been increasingly used for AF risk prediction. We compared CHARGE-AF risk score versus CHA₂DS₂-VASc risk score for incident AF risk in a community-based cohort.

Methods and Results

We studied Framingham Heart Study participants aged 46 to 94 years without prevalent AF and with complete covariates. We predicted AF risk using Fine-Gray proportional sub-distribution hazards regression. We used the Wald χ² statistic for model fit, C-statistic for discrimination, and Hosmer-Lemeshow (HL) χ² statistic for calibration.

We included 9722 observations (mean age 63.9 ± 10.6 years, 56% women) from 4548 unique individuals: 752 (16.5%) developed incident AF and 793 (17.4%) died. The mean CHARGE-AF score was 12.0 ± 1.2 and the sub-distribution hazard ratio (sHR) for AF per unit increment was 2.15 (95% CI, 99-131%; P < .0001). The mean CHA₂DS₂-VASc score was 2.0 ± 1.5 and the sHR for AF per unit increment was 1.43 (95% CI, 37%-51%; P < .0001). The CHARGE-AF model had better fit than CHA₂DS₂-VASc (Wald χ² = 403 vs 209, both with 1 df), improved discrimination (C-statistic = 0.75, 95% CI, 0.73-0.76 vs C-statistic = 0.71, 95% CI, 0.69-0.73), and better calibration (HL χ² = 5.6, P = .69 vs HL χ² = 28.5, P < .0001).

Conclusion

The CHARGE-AF risk score performed better than the CHA₂DS₂-VASc risk score at predicting AF in a community-based cohort.