CLINICAL QUESTION

How can patients at high risk for developing atrial fibrillation (AF) be identified?

EVIDENCE SUMMARY

AF is the most common arrhythmia worldwide and is associated with an increased risk of stroke, heart failure, and death.¹ Risk factors for AF include older age, hypertension, alcohol consumption, tobacco use, and a history of vascular disease. Many prediction models for identifying people at high risk for incident (new onset) AF have been developed, including the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF and Framingham Heart Study (FHS)-AF risk scores.

The CHARGE-AF risk score was developed using data from three large US cohorts with a total of 18,556 participants (mean age 60–73 years), and it was validated in 7,672 participants from two European cohorts (mean age 72–76 years).² The calculator is a multivariate model with 13 predictors, including electrocardiography (ECG). This creates a high data burden, although a spreadsheet is provided by the authors. The area under the receiver operating characteristic curve (AUROC), a measure of overall accuracy, was 0.76 in the derivation cohorts but 0.66 and 0.70 in the two validation cohorts, indicating only fair accuracy.