Lancet: Primary-care predictive tool could identify people at risk for a-fib

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Scientists have developed a risk score that could help to identify people at risk of atrial fibrillation in the primary-care setting, and may also aid the targeting of prevention measures at high-risk individuals, according to study in the Feb. 28 issue of the Lancet.

Renate Schnabel, MD, from the Johannes Gutenberg-University in Mainz, Germany, and Emelia Benjamin, MD, from Boston University School of Medicine, and colleagues, aimed to create a new way to score an individual's risk using clinical characteristics that can be easily assessed in primary-care settings.

Using data from the Framingham Heart Study, they selected 4764 individuals aged 45 years who did not have atrial fibrillation, from 80,444 exams done between June 1968 and September 1987. Researchers followed participants over 10 years and monitored for atrial fibrillation, to develop a risk score from clinical characteristics, exam and echocardiographic measures.

Investigators found that 10 percent of the participants developed atrial fibrillation over the 10 years. Age, sex, body-mass index, systolic blood pressure, treatment for hypertension, PR interval, clinically significant heart murmur and heart failure were the strongest risk factors associated with atrial fibrillation, and were included in the final model. The researchers developed a scoring system for each of the risk factors and assigned the total score to an absolute risk of developing atrial fibrillation over 10 years.

The risk score was shown to have good predictive value and had similar accuracy in both young and old individuals, according to the authors. The score was only slightly improved by the inclusion of standard echocardiographic measures.

The risk of atrial fibrillation in 10 years was shown to vary with age--1 percent of participants younger than 65 years had more than 15 percent risk, compared with 27 percent older than 65 years.

The authors reported that the "risk prediction score provides clinicians with an easily applicable method to improve risk assessment and communication of risk for individuals, and targeting intervention in routine clinical practice."

In an accompanying commentary, David Brieger, MD, and Ben Freedman, MD, from Concord Hospital, University of Sydney in Australia, wrote that "atrial fibrillation is the most common sustained arrhythmia, and is associated with a doubling of the...mortality rate...particularly within the first four months of diagnosis...With this condition, few would argue against the assertion that an ounce of prevention is worth a pound of cure. This predictive model is the first step in that direction."

They concluded that identification of a group at increased risk of development of atrial fibrillation would make it possible to test new or currently available therapies which might prevent this arrhythmia.