Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN.
Am J Med. 2023 Mar;136(3):302-307. doi: 10.1016/j.amjmed.2022.11.010. Epub 2022 Dec 8.
The Framingham Heart Study Dementia Risk Score (FDRS) was developed in a general population of older persons. It is unknown how the FDRS variables predict Alzheimer's disease and Alzheimer's disease-related dementias (AD/ADRD) in heart failure and atrial fibrillation populations. We aimed to evaluate the predictive ability of the FDRS variables in population-based cohorts of heart failure and atrial fibrillation and to determine whether the addition of other comorbidities and risk factors improves risk prediction for AD/ADRD.
Residents aged ≥50 years from 7 southeastern Minnesota counties with a first diagnosis of heart failure or atrial fibrillation between January 1, 2013, and December 31, 2017, were identified. Patients with AD/ADRD before or within 6 months after index atrial fibrillation or heart failure and patients who died within 6 months after index were excluded. For both cohorts, models were constructed to predict AD/ADRD after index including the variables in the FDRS. Additional comorbidities and risk factors were added to the models. For all models, c-statistics using 5-fold cross-validation were calculated.
Among 3052 patients with heart failure (mean age 75 years, 53% male), 626 developed AD/ADRD; among 4107 patients with atrial fibrillation (mean age 74 years, 57% male), 736 developed AD/ADRD. Among patients with heart failure, the FDRS variables predicted AD/ADRD with c-statistic = 0.69. Adding comorbidities and risk factors improved the c-statistic slightly to 0.70. The FDRS variables also performed well (c-statistic = 0.73) in patients with atrial fibrillation; adding comorbidities and risk factors slightly improved performance (c-statistic = 0.75).
The variables from the FDRS predict AD/ADRD well in both heart failure and atrial fibrillation populations. The addition of comorbidities and risk factors only modestly improved prediction, indicating that the FDRS variables are appropriate to predict AD/ADRD in patients with heart failure and atrial fibrillation.
弗雷明汉心脏研究痴呆风险评分（FDRS）是在老年人群中开发的。目前尚不清楚 FDRS 变量如何预测心力衰竭和心房颤动人群中的阿尔茨海默病和阿尔茨海默病相关痴呆症（AD/ADRD）。我们旨在评估 FDRS 变量在基于人群的心力衰竭和心房颤动队列中的预测能力，并确定是否添加其他合并症和危险因素可以提高 AD/ADRD 的风险预测。
从 2013 年 1 月 1 日至 2017 年 12 月 31 日，在明尼苏达州东南部的 7 个县识别出首次诊断为心力衰竭或心房颤动的年龄≥50 岁的居民。排除在心房颤动或心力衰竭指数前或指数后 6 个月内患有 AD/ADRD 的患者，以及指数后 6 个月内死亡的患者。对于两个队列，构建了用于预测指数后 AD/ADRD 的模型，包括 FDRS 中的变量。向模型中添加了其他合并症和危险因素。对于所有模型，均使用 5 折交叉验证计算 C 统计量。
在 3052 例心力衰竭患者（平均年龄 75 岁，53%为男性）中，有 626 例发展为 AD/ADRD；在 4107 例心房颤动患者（平均年龄 74 岁，57%为男性）中，有 736 例发展为 AD/ADRD。在心力衰竭患者中，FDRS 变量预测 AD/ADRD 的 C 统计量为 0.69。添加合并症和危险因素后，C 统计量略有提高至 0.70。FDRS 变量在心房颤动患者中表现也良好（C 统计量为 0.73）；添加合并症和危险因素后，性能略有提高（C 统计量为 0.75）。
FDRS 的变量在心力衰竭和心房颤动人群中均能很好地预测 AD/ADRD。添加合并症和危险因素仅略微改善了预测，表明 FDRS 变量适合预测心力衰竭和心房颤动患者的 AD/ADRD。
