具有受限平均生存时间的心房颤动新型风险建模方法：在弗雷明汉心脏研究社区队列中的应用
Novel Risk Modeling Approach of Atrial Fibrillation With Restricted Mean Survival Times: Application in the Framingham Heart Study Community-Based Cohort.
作者信息
Staerk Laila, Preis Sarah R, Lin Honghuang, Casas Juan P, Lunetta Kathryn, Weng Lu-Chen, Anderson Christopher D, Ellinor Patrick T, Lubitz Steven A, Benjamin Emelia J, Trinquart Ludovic
机构信息
National Heart, Lung, and Blood Institute, Boston University's Framingham Heart Study, MA (L.S., S.R.P., H.L., E.J.B., L.T.).
Department of Cardiology, Copenhagen University Hospital Herlev and Gentofte, Helleup, Denmark (L.S.).
出版信息
Circ Cardiovasc Qual Outcomes. 2020 Apr;13(4):e005918. doi: 10.1161/CIRCOUTCOMES.119.005918. Epub 2020 Mar 31.
BACKGROUND
Risk prediction models for atrial fibrillation (AF) do not give information about when AF might develop. Restricted mean survival time (RMST) quantifies risk into the time domain. Our objective was to use RMST to re-express individualized AF risk predictions.
METHODS AND RESULTS
We included AF-free participants from the Framingham Heart Study community-based cohorts. We predicted new-onset AF over 10-year follow-up according to baseline covariates: age, height, weight, systolic blood pressure, diastolic blood pressure, current smoking, antihypertensive treatment, diabetes mellitus, prevalent heart failure, and prevalent myocardial infarction. First, we fitted a Cox regression model and estimated the 10-year predicted risk of AF. Second, we fitted an RMST model and estimated the predicted mean time free of AF and alive over a time horizon of 10 years. We included 7586 AF-free participants contributing to 11 088 examinations (mean age 61±11 years, 44% were men). During 10-year follow-up, 822 participants developed AF. The Cox and RMST models were in agreement regarding the direction, strength, and statistical significance of associations for all covariates. Low (<5%), intermediate (5%-15%), and high (>15%) 10-year predicted risk of AF corresponded to predicted mean time alive and free of AF of 9.9, 9.6, and 8.8 years, respectively. A 60-year-old woman with a body mass index of 25 kg/m, no use of hypertension treatment and no history of heart failure had a predicted mean time alive and free of AF of 9.9 years, whereas a 70-year-old man with a body mass index of 30 kg/m, use of hypertension treatment, and with prevalent heart failure had a predicted mean time alive and free of AF of 7.9 years.
CONCLUSIONS
The RMST can be used to develop risk prediction models to express results in a time scale. RMST may offer a complementary risk communication tool for AF in clinical practice.
背景
心房颤动（AF）的风险预测模型无法提供AF可能何时发生的信息。受限平均生存时间（RMST）将风险量化到时间领域。我们的目标是使用RMST重新表达个体化的AF风险预测。
方法与结果
我们纳入了弗雷明汉心脏研究社区队列中无AF的参与者。根据基线协变量预测10年随访期间新发AF：年龄、身高、体重、收缩压、舒张压、当前吸烟情况、抗高血压治疗、糖尿病、既往心力衰竭和既往心肌梗死。首先，我们拟合了Cox回归模型并估计了AF的10年预测风险。其次，我们拟合了RMST模型并估计了10年时间范围内无AF且存活的预测平均时间。我们纳入了7586名无AF的参与者，共进行了11088次检查（平均年龄61±11岁，44%为男性）。在10年随访期间，822名参与者发生了AF。Cox模型和RMST模型在所有协变量关联的方向、强度和统计显著性方面均一致。AF的10年预测低风险（<5%）、中风险（5%-15%）和高风险（>15%）分别对应无AF且存活的预测平均时间为9.9年、9.6年和8.8年。一名60岁、体重指数为25kg/m²、未接受高血压治疗且无心力衰竭病史的女性，其无AF且存活的预测平均时间为9.9年，而一名70岁、体重指数为30kg/m²、接受高血压治疗且有既往心力衰竭的男性，其无AF且存活的预测平均时间为7.9年。
结论
RMST可用于开发风险预测模型，以便在时间尺度上表达结果。RMST可能为临床实践中AF提供一种补充性的风险沟通工具。
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