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Atrial ectopy as a predictor of incident atrial fibrillation: a cohort study.
Tuesday,2013-12-10 10:43 America/Los_Angeles — poolea2
| Title | Atrial ectopy as a predictor of incident atrial fibrillation: a cohort study. |
| Publication Type | Journal Article |
| Year of Publication | 2013 |
| Authors | Dewland, TA, Vittinghoff, E, Mandyam, MC, Heckbert, SR, Siscovick, DS, Stein, PK, Psaty, BM, Sotoodehnia, N, Gottdiener, JS, Marcus, GM |
| Journal | Ann Intern Med |
| Volume | 159 |
| Issue | 11 |
| Pagination | 721-8 |
| Date Published | 2013 Dec 03 |
| ISSN | 1539-3704 |
| Keywords | Aged, Atrial Fibrillation, Atrial Function, Cause of Death, Electrocardiography, Female, Humans, Male, Models, Statistical, Myocardial Contraction, Prospective Studies, Risk Assessment |
| Abstract | <p><b>BACKGROUND: </b>Atrial fibrillation (AF) prediction models have unclear clinical utility given the absence of AF prevention therapies and the immutability of many risk factors. Premature atrial contractions (PACs) play a critical role in AF pathogenesis and may be modifiable.</p><p><b>OBJECTIVE: </b>To investigate whether PAC count improves model performance for AF risk.</p><p><b>DESIGN: </b>Prospective cohort study.</p><p><b>SETTING: </b>4 U.S. communities.</p><p><b>PATIENTS: </b>A random subset of 1260 adults without prevalent AF enrolled in the Cardiovascular Health Study between 1989 and 1990.</p><p><b>MEASUREMENTS: </b>The PAC count was quantified by 24-hour electrocardiography. Participants were followed for the diagnosis of incident AF or death. The Framingham AF risk algorithm was used as the comparator prediction model.</p><p><b>RESULTS: </b>In adjusted analyses, doubling the hourly PAC count was associated with a significant increase in AF risk (hazard ratio, 1.17 [95% CI, 1.13 to 1.22]; P < 0.001) and overall mortality (hazard ratio, 1.06 [CI, 1.03 to 1.09]; P < 0.001). Compared with the Framingham model, PAC count alone resulted in similar AF risk discrimination at 5 and 10 years of follow-up and superior risk discrimination at 15 years. The addition of PAC count to the Framingham model resulted in significant 10-year AF risk discrimination improvement (c-statistic, 0.65 vs. 0.72; P < 0.001), net reclassification improvement (23.2% [CI, 12.8% to 33.6%]; P < 0.001), and integrated discrimination improvement (5.6% [CI, 4.2% to 7.0%]; P < 0.001). The specificity for predicting AF at 15 years exceeded 90% for PAC counts more than 32 beats/h.</p><p><b>LIMITATION: </b>This study does not establish a causal link between PACs and AF.</p><p><b>CONCLUSION: </b>The addition of PAC count to a validated AF risk algorithm provides superior AF risk discrimination and significantly improves risk reclassification. Further study is needed to determine whether PAC modification can prospectively reduce AF risk.</p><p><b>PRIMARY FUNDING SOURCE: </b>American Heart Association, Joseph Drown Foundation, and National Institutes of Health.</p> |
| DOI | 10.7326/0003-4819-159-11-201312030-00004 |
| Alternate Journal | Ann. Intern. Med. |
| PubMed ID | 24297188 |
| PubMed Central ID | PMC4115459 |
| Grant List | N01HC55222 / HC / NHLBI NIH HHS / United States N01 HC085086 / HC / NHLBI NIH HHS / United States N01 HC085081 / HC / NHLBI NIH HHS / United States N01HC85239 / HC / NHLBI NIH HHS / United States N01HC85080 / HC / NHLBI NIH HHS / United States U01 HL080295 / HL / NHLBI NIH HHS / United States R01HL116747 / HL / NHLBI NIH HHS / United States N01 HC085083 / HC / NHLBI NIH HHS / United States N01HC55222 / HL / NHLBI NIH HHS / United States N01HC85086 / HL / NHLBI NIH HHS / United States N01 HC085082 / HC / NHLBI NIH HHS / United States N01HC85081 / HC / NHLBI NIH HHS / United States N01 HC085080 / HC / NHLBI NIH HHS / United States N01HC85079 / HC / NHLBI NIH HHS / United States HHSN268201200036C / HL / NHLBI NIH HHS / United States N01HC85086 / HC / NHLBI NIH HHS / United States R01 HL080295 / HL / NHLBI NIH HHS / United States N01HC85082 / HC / NHLBI NIH HHS / United States N01HC85082 / HL / NHLBI NIH HHS / United States N01HC85083 / HL / NHLBI NIH HHS / United States HHSN268201200036C / / PHS HHS / United States HL080295 / HL / NHLBI NIH HHS / United States N01HC85083 / HC / NHLBI NIH HHS / United States N01HC85079 / HL / NHLBI NIH HHS / United States N01 HC085079 / HC / NHLBI NIH HHS / United States R01 AG023629 / AG / NIA NIH HHS / United States N01HC85080 / HL / NHLBI NIH HHS / United States AG023629 / AG / NIA NIH HHS / United States R56 AG023629 / AG / NIA NIH HHS / United States R01 HL116747 / HL / NHLBI NIH HHS / United States N01HC85081 / HL / NHLBI NIH HHS / United States |