School of Dentistry, University of Leeds, Leeds, UK.
Leeds Institute of Data Analytics, University of Leeds, Leeds, UK
Open Heart. 2023 Jul;10(2). doi: 10.1136/openhrt-2023-002357.
Risk-guided atrial fibrillation (AF) screening may be an opportunity to prevent adverse events in addition to stroke. We compared events rates for new diagnoses of cardio-renal-metabolic diseases and death in individuals identified at higher versus lower-predicted AF risk.
From the UK Clinical Practice Research Datalink-GOLD dataset, 2 January 1998-30 November 2018, we identified individuals aged ≥30 years without known AF. The risk of AF was estimated using the FIND-AF (Future Innovations in Novel Detection of Atrial Fibrillation) risk score. We calculated cumulative incidence rates and fit Fine and Gray's models at 1, 5 and 10 years for nine diseases and death adjusting for competing risks.
Of 416 228 individuals in the cohort, 82 942 were identified as higher risk for AF. Higher-predicted risk, compared with lower-predicted risk, was associated with incident chronic kidney disease (cumulative incidence per 1000 persons at 10 years 245.2; HR 6.85, 95% CI 6.70 to 7.00; median time to event 5.44 years), heart failure (124.7; 12.54, 12.08 to 13.01; 4.06), diabetes mellitus (123.3; 2.05, 2.00 to 2.10; 3.45), stroke/transient ischaemic attack (118.9; 8.07, 7.80 to 8.34; 4.27), myocardial infarction (69.6; 5.02, 4.82 to 5.22; 4.32), peripheral vascular disease (44.6; 6.62, 6.28 to 6.98; 4.28), valvular heart disease (37.8; 6.49, 6.14 to 6.85; 4.54), aortic stenosis (18.7; 9.98, 9.16 to 10.87; 4.41) and death from any cause (273.9; 10.45, 10.23 to 10.68; 4.75). The higher-risk group constituted 74% of deaths from cardiovascular or cerebrovascular causes (8582 of 11 676).
Individuals identified for risk-guided AF screening are at risk of new diseases across the cardio-renal-metabolic spectrum and death, and may benefit from interventions beyond ECG monitoring.
风险指导的心房颤动（AF）筛查除了预防中风外，还可能有机会预防不良事件。我们比较了在预测 AF 风险较高和较低的个体中新诊断出的心血管-肾脏-代谢疾病和死亡的发生率。
我们从英国临床实践研究数据链接-GOLD 数据集（1998 年 2 月 1 日至 2018 年 11 月 30 日）中，确定了年龄≥30 岁且无已知 AF 的个体。使用 FIND-AF（未来创新的心房颤动新型检测）风险评分来估计 AF 的风险。我们计算了 9 种疾病和死亡的累积发病率，并在 1、5 和 10 年内根据竞争风险调整 Fine 和 Gray 的模型。
在队列中的 416228 名个体中，有 82942 名被确定为 AF 风险较高。与低风险预测相比，高风险预测与慢性肾脏病（10 年内每 1000 人累积发病率为 245.2；HR6.85，95%CI6.70 至 7.00；中位时间至事件 5.44 年）、心力衰竭（124.7；12.54，12.08 至 13.01；4.06）、糖尿病（123.3；2.05，2.00 至 2.10；3.45）、中风/短暂性脑缺血发作（118.9；8.07，7.80 至 8.34；4.27）、心肌梗死（69.6；5.02，4.82 至 5.22；4.32）、外周血管疾病（44.6；6.62，6.28 至 6.98；4.28）、瓣膜性心脏病（37.8；6.49，6.14 至 6.85；4.54）、主动脉瓣狭窄（18.7；9.98，9.16 至 10.87；4.41）和任何原因导致的死亡（273.9；10.45，10.23 至 10.68；4.75）有关。高危组构成了心血管或脑血管原因导致的死亡的 74%（11676 例中的 8582 例）。
接受风险指导的 AF 筛查的个体存在发生心血管-肾脏-代谢疾病谱和死亡的新疾病风险，并且可能受益于心电图监测以外的干预措施。
