Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study
Objective 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.Methods From the...
| Main Authors: | , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMJ Publishing Group
2023-11-01
|
| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/10/2/e002357.full |
| _version_ | 1797367138694987776 |
|---|---|
| author | Chris P Gale Jianhua Wu Ramesh Nadarajah Ronen Arbel David Hogg Yoko M Nakao Campbel Cowan Keerthenan Raveendra Kazuhiro Nakao Moti Haim Doron Zahger |
| author_facet | Chris P Gale Jianhua Wu Ramesh Nadarajah Ronen Arbel David Hogg Yoko M Nakao Campbel Cowan Keerthenan Raveendra Kazuhiro Nakao Moti Haim Doron Zahger |
| author_sort | Chris P Gale |
| collection | DOAJ |
| description | Objective 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.Methods 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.Results 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).Conclusions 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. |
| first_indexed | 2024-03-08T17:14:04Z |
| format | Article |
| id | doaj.art-9f1a94cb5f654e0e82d543220fe056cf |
| institution | Directory Open Access Journal |
| issn | 2053-3624 |
| language | English |
| last_indexed | 2024-03-08T17:14:04Z |
| publishDate | 2023-11-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | Open Heart |
| spelling | doaj.art-9f1a94cb5f654e0e82d543220fe056cf2024-01-03T17:50:08ZengBMJ Publishing GroupOpen Heart2053-36242023-11-0110210.1136/openhrt-2023-002357Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort studyChris P Gale0Jianhua Wu1Ramesh Nadarajah2Ronen Arbel3David Hogg4Yoko M Nakao5Campbel Cowan6Keerthenan Raveendra7Kazuhiro Nakao8Moti Haim9Doron Zahger10Department of Cardiology, Leeds Teaching Hospitals NHS Trust, Leeds, UKLeeds Institute of Data Analytics, University of Leeds, Leeds, UKLeeds Institute of Data Analytics, University of Leeds, Leeds, UKHealth Systems Management, Ben-Gurion University of the Negev, Beer-Sheva, IsraelSchool of Computing, University of Leeds, Leeds, UKLeeds Institute of Data Analytics, University of Leeds, Leeds, UKDepartment of Cardiology, Leeds General Infirmary, Leeds, UKMedical School, University of Leeds, Leeds, UKDepartment of Cardiovascular Medicine, National Cerebral and Cardiovascular Center, Suita, JapanDepartment of Cardiology, Soroka University Medical Center, Beer Sheva, IsraelSoroka University Medical Center, Beer Sheva, IsraelObjective 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.Methods 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.Results 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).Conclusions 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.https://openheart.bmj.com/content/10/2/e002357.full |
| spellingShingle | Chris P Gale Jianhua Wu Ramesh Nadarajah Ronen Arbel David Hogg Yoko M Nakao Campbel Cowan Keerthenan Raveendra Kazuhiro Nakao Moti Haim Doron Zahger Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study Open Heart |
| title | Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study |
| title_full | Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study |
| title_fullStr | Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study |
| title_full_unstemmed | Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study |
| title_short | Incident cardiovascular, renal, metabolic diseases and death in individuals identified for risk-guided atrial fibrillation screening: a nationwide cohort study |
| title_sort | incident cardiovascular renal metabolic diseases and death in individuals identified for risk guided atrial fibrillation screening a nationwide cohort study |
| url | https://openheart.bmj.com/content/10/2/e002357.full |
| work_keys_str_mv | AT chrispgale incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT jianhuawu incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT rameshnadarajah incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT ronenarbel incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT davidhogg incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT yokomnakao incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT campbelcowan incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT keerthenanraveendra incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT kazuhironakao incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT motihaim incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy AT doronzahger incidentcardiovascularrenalmetabolicdiseasesanddeathinindividualsidentifiedforriskguidedatrialfibrillationscreeninganationwidecohortstudy |