TY - JOUR
T1 - CHARGE-AF in a national routine primary care electronic health records database in the Netherlands: Validation for 5-year risk of atrial fibrillation and implications for patient selection in atrial fibrillation screening
AU - Himmelreich, Jelle C. L.
AU - Lucassen, Wim A. M.
AU - Harskamp, Ralf E.
AU - Aussems, Claire
AU - van Weert, Henk C. P. M.
AU - Nielen, Mark M. J.
N1 - Funding Information: Funding This work was supported by the Netherlands Organisation for Health Research and Development (ZonMw) (80-83910-98-13046) and the European Research Council under the European Union’s Horizon 2020 research and innovation programme (648 131). The authors had full autonomy in design, conduct and reporting of the manuscript. Publisher Copyright: © 2021 BMJ Publishing Group. All rights reserved.
PY - 2021/1/18
Y1 - 2021/1/18
N2 - Aims To validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF's potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data. Methods We included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients. Results Among 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF's C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%-5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2 DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts. Conclusion In patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2 DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.
AB - Aims To validate a multivariable risk prediction model (Cohorts for Heart and Aging Research in Genomic Epidemiology model for atrial fibrillation (CHARGE-AF)) for 5-year risk of atrial fibrillation (AF) in routinely collected primary care data and to assess CHARGE-AF's potential for automated, low-cost selection of patients at high risk for AF based on routine primary care data. Methods We included patients aged ≥40 years, free of AF and with complete CHARGE-AF variables at baseline, 1 January 2014, in a representative, nationwide routine primary care database in the Netherlands (Nivel-PCD). We validated CHARGE-AF for 5-year observed AF incidence using the C-statistic for discrimination, and calibration plot and stratified Kaplan-Meier plot for calibration. We compared CHARGE-AF with other predictors and assessed implications of using different CHARGE-AF cut-offs to select high-risk patients. Results Among 111 475 patients free of AF and with complete CHARGE-AF variables at baseline (17.2% of all patients aged ≥40 years and free of AF), mean age was 65.5 years, and 53% were female. Complete CHARGE-AF cases were older and had higher AF incidence and cardiovascular comorbidity rate than incomplete cases. There were 5264 (4.7%) new AF cases during 5-year follow-up among complete cases. CHARGE-AF's C-statistic for new AF was 0.74 (95% CI 0.73 to 0.74). The calibration plot showed slight risk underestimation in low-risk deciles and overestimation of absolute AF risk in those with highest predicted risk. The Kaplan-Meier plot with categories <2.5%, 2.5%-5% and >5% predicted 5-year risk was highly accurate. CHARGE-AF outperformed CHA2 DS2-VASc (Cardiac failure or dysfunction, Hypertension, Age >=75 [Doubled], Diabetes, Stroke [Doubled]-Vascular disease, Age 65-74, and Sex category [Female]) and age alone as predictors for AF. Dichotomisation at cut-offs of 2.5%, 5% and 10% baseline CHARGE-AF risk all showed merits for patient selection in AF screening efforts. Conclusion In patients with complete baseline CHARGE-AF data through routine Dutch primary care, CHARGE-AF accurately assessed AF risk among older primary care patients, outperformed both CHA2 DS2-VASc and age alone as predictors for AF and showed potential for automated, low-cost patient selection in AF screening.
KW - Atrial fibrillation
KW - electronic health records
KW - epidemiology
KW - risk factors
UR - http://www.scopus.com/inward/record.url?scp=85100104739&partnerID=8YFLogxK
U2 - https://doi.org/10.1136/openhrt-2020-001459
DO - https://doi.org/10.1136/openhrt-2020-001459
M3 - Article
C2 - 33462107
SN - 2398-595X
VL - 8
JO - Open Heart
JF - Open Heart
IS - 1
M1 - e001459
ER -