Shaan Khurshid1,2, Uri Kartoun3, Jeffrey M Ashburner1,4, Ludovic Trinquart5,6, Anthony Philippakis1, Amit V Khera1, Patrick T Ellinor1,7, Kenney Ng3, Steven A Lubitz1,7. 1. Cardiovascular Disease Initiative, Broad Institute of the Massachusetts Institute of Technology & Harvard University, Cambridge (S.K., J.M.A., A.P., A.V.K., P.T.E., S.A.L.). 2. Division of Cardiology (S.K.), Massachusetts General Hospital, Boston. 3. Center for Computational Health, IBM Research, Cambridge, MA (U.K., K.N.). 4. Division of General Internal Medicine (J.M.A.), Massachusetts General Hospital, Boston. 5. Department of Biostatistics, Boston University School of Public Health, Boston, MA (L.T.). 6. Boston University and National Heart, Lung, and Blood Institute's Framingham Heart Study, MA (L.T.). 7. Cardiac Arrhythmia Service (P.T.E., S.A.L.), Massachusetts General Hospital, Boston.
Abstract
BACKGROUND: Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. Electronic health record (EHR)-based AF risk prediction may facilitate efficient deployment of interventions to diagnose or prevent AF altogether. METHODS: We externally validated an electronic health record AF (EHR-AF) score in IBM Explorys Life Sciences, a multi-institutional dataset containing statistically deidentified EHR data for over 21 million individuals (Explorys Dataset). We included individuals with complete AF risk data, ≥2 office visits within 2 years, and no prevalent AF. We compared EHR-AF to existing scores including CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation), C2HEST (coronary artery disease or chronic obstructive pulmonary disease, hypertension, elderly, systolic heart failure, thyroid disease), and CHA2DS2-VASc. We assessed association between AF risk scores and 5-year incident AF, stroke, and heart failure using Cox proportional hazards modeling, 5-year AF discrimination using C indices, and calibration of predicted AF risk to observed AF incidence. RESULTS: Of 21 825 853 individuals in the Explorys Dataset, 4 508 180 comprised the analysis (age 62.5, 56.3% female). AF risk scores were strongly associated with 5-year incident AF (hazard ratio per SD increase 1.85 using CHA2DS2-VASc to 2.88 using EHR-AF), stroke (1.61 using C2HEST to 1.92 using CHARGE-AF), and heart failure (1.91 using CHA2DS2-VASc to 2.58 using EHR-AF). EHR-AF (C index, 0.808 [95% CI, 0.807-0.809]) demonstrated favorable AF discrimination compared to CHARGE-AF (0.806 [95% CI, 0.805-0.807]), C2HEST (0.683 [95% CI, 0.682-0.684]), and CHA2DS2-VASc (0.720 [95% CI, 0.719-0.722]). Of the scores, EHR-AF demonstrated the best calibration to incident AF (calibration slope, 1.002 [95% CI, 0.997-1.007]). In subgroup analyses, AF discrimination using EHR-AF was lower in individuals with stroke (C index, 0.696 [95% CI, 0.692-0.700]) and heart failure (0.621 [95% CI, 0.617-0.625]). CONCLUSIONS: EHR-AF demonstrates predictive accuracy for incident AF using readily ascertained EHR data. AF risk is associated with incident stroke and heart failure. Use of such risk scores may facilitate decision support and population health management efforts focused on minimizing AF-related morbidity.
BACKGROUND: Atrial fibrillation (AF) is associated with increased risks of stroke and heart failure. Electronic health record (EHR)-based AF risk prediction may facilitate efficient deployment of interventions to diagnose or prevent AF altogether. METHODS: We externally validated an electronic health record AF (EHR-AF) score in IBM Explorys Life Sciences, a multi-institutional dataset containing statistically deidentified EHR data for over 21 million individuals (Explorys Dataset). We included individuals with complete AF risk data, ≥2 office visits within 2 years, and no prevalent AF. We compared EHR-AF to existing scores including CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology Atrial Fibrillation), C2HEST (coronary artery disease or chronic obstructive pulmonary disease, hypertension, elderly, systolic heart failure, thyroid disease), and CHA2DS2-VASc. We assessed association between AF risk scores and 5-year incident AF, stroke, and heart failure using Cox proportional hazards modeling, 5-year AF discrimination using C indices, and calibration of predicted AF risk to observed AF incidence. RESULTS: Of 21 825 853 individuals in the Explorys Dataset, 4 508 180 comprised the analysis (age 62.5, 56.3% female). AF risk scores were strongly associated with 5-year incident AF (hazard ratio per SD increase 1.85 using CHA2DS2-VASc to 2.88 using EHR-AF), stroke (1.61 using C2HEST to 1.92 using CHARGE-AF), and heart failure (1.91 using CHA2DS2-VASc to 2.58 using EHR-AF). EHR-AF (C index, 0.808 [95% CI, 0.807-0.809]) demonstrated favorable AF discrimination compared to CHARGE-AF (0.806 [95% CI, 0.805-0.807]), C2HEST (0.683 [95% CI, 0.682-0.684]), and CHA2DS2-VASc (0.720 [95% CI, 0.719-0.722]). Of the scores, EHR-AF demonstrated the best calibration to incident AF (calibration slope, 1.002 [95% CI, 0.997-1.007]). In subgroup analyses, AF discrimination using EHR-AF was lower in individuals with stroke (C index, 0.696 [95% CI, 0.692-0.700]) and heart failure (0.621 [95% CI, 0.617-0.625]). CONCLUSIONS: EHR-AF demonstrates predictive accuracy for incident AF using readily ascertained EHR data. AF risk is associated with incident stroke and heart failure. Use of such risk scores may facilitate decision support and population health management efforts focused on minimizing AF-related morbidity.
Entities:
Keywords:
atrial fibrillation; electronic health record; heart failure; incidence; risk
Authors: Carlos J Rodriguez; Elsayed Z Soliman; Alvaro Alonso; Katrina Swett; Peter M Okin; David C Goff; Susan R Heckbert Journal: Ann Epidemiol Date: 2014-11-28 Impact factor: 3.797
Authors: Melissa E Middeldorp; Rajeev K Pathak; Megan Meredith; Abhinav B Mehta; Adrian D Elliott; Rajiv Mahajan; Darragh Twomey; Celine Gallagher; Jeroen M L Hendriks; Dominik Linz; R Doug McEvoy; Walter P Abhayaratna; Jonathan M Kalman; Dennis H Lau; Prashanthan Sanders Journal: Europace Date: 2018-12-01 Impact factor: 5.214
Authors: Scott D Corley; Andrew E Epstein; John P DiMarco; Michael J Domanski; Nancy Geller; H Leon Greene; Richard A Josephson; Joyce C Kellen; Richard C Klein; Andrew D Krahn; Mary Mickel; L Brent Mitchell; Joy Dalquist Nelson; Yves Rosenberg; Eleanor Schron; Lynn Shemanski; Albert L Waldo; D George Wyse Journal: Circulation Date: 2004-03-08 Impact factor: 29.690
Authors: Eric Shulman; Faraj Kargoli; Philip Aagaard; Ethan Hoch; Luigi Di Biase; John Fisher; Jay Gross; Soo Kim; Andrew Krumerman; Kevin J Ferrick Journal: Am J Cardiol Date: 2015-10-19 Impact factor: 2.778
Authors: Shaan Khurshid; Samuel Friedman; Christopher Reeder; Paolo Di Achille; Nathaniel Diamant; Pulkit Singh; Lia X Harrington; Xin Wang; Mostafa A Al-Alusi; Gopal Sarma; Andrea S Foulkes; Patrick T Ellinor; Christopher D Anderson; Jennifer E Ho; Anthony A Philippakis; Puneet Batra; Steven A Lubitz Journal: Circulation Date: 2021-11-08 Impact factor: 29.690
Authors: Shaan Khurshid; Nina Mars; Christopher M Haggerty; Qiuxi Huang; Lu-Chen Weng; Dustin N Hartzel; Kathryn L Lunetta; Jeffrey M Ashburner; Christopher D Anderson; Emelia J Benjamin; Veikko Salomaa; Patrick T Ellinor; Brandon K Fornwalt; Samuli Ripatti; Ludovic Trinquart; Steven A Lubitz Journal: Circ Genom Precis Med Date: 2021-08-31
Authors: Shinwan Kany; Bruno Reissmann; Andreas Metzner; Paulus Kirchhof; Dawood Darbar; Renate B Schnabel Journal: Cardiovasc Res Date: 2021-06-16 Impact factor: 10.787
Authors: Heidi L Rehm; Angela J H Page; Lindsay Smith; Jeremy B Adams; Gil Alterovitz; Lawrence J Babb; Maxmillian P Barkley; Michael Baudis; Michael J S Beauvais; Tim Beck; Jacques S Beckmann; Sergi Beltran; David Bernick; Alexander Bernier; James K Bonfield; Tiffany F Boughtwood; Guillaume Bourque; Sarion R Bowers; Anthony J Brookes; Michael Brudno; Matthew H Brush; David Bujold; Tony Burdett; Orion J Buske; Moran N Cabili; Daniel L Cameron; Robert J Carroll; Esmeralda Casas-Silva; Debyani Chakravarty; Bimal P Chaudhari; Shu Hui Chen; J Michael Cherry; Justina Chung; Melissa Cline; Hayley L Clissold; Robert M Cook-Deegan; Mélanie Courtot; Fiona Cunningham; Miro Cupak; Robert M Davies; Danielle Denisko; Megan J Doerr; Lena I Dolman; Edward S Dove; L Jonathan Dursi; Stephanie O M Dyke; James A Eddy; Karen Eilbeck; Kyle P Ellrott; Susan Fairley; Khalid A Fakhro; Helen V Firth; Michael S Fitzsimons; Marc Fiume; Paul Flicek; Ian M Fore; Mallory A Freeberg; Robert R Freimuth; Lauren A Fromont; Jonathan Fuerth; Clara L Gaff; Weiniu Gan; Elena M Ghanaim; David Glazer; Robert C Green; Malachi Griffith; Obi L Griffith; Robert L Grossman; Tudor Groza; Jaime M Guidry Auvil; Roderic Guigó; Dipayan Gupta; Melissa A Haendel; Ada Hamosh; David P Hansen; Reece K Hart; Dean Mitchell Hartley; David Haussler; Rachele M Hendricks-Sturrup; Calvin W L Ho; Ashley E Hobb; Michael M Hoffman; Oliver M Hofmann; Petr Holub; Jacob Shujui Hsu; Jean-Pierre Hubaux; Sarah E Hunt; Ammar Husami; Julius O Jacobsen; Saumya S Jamuar; Elizabeth L Janes; Francis Jeanson; Aina Jené; Amber L Johns; Yann Joly; Steven J M Jones; Alexander Kanitz; Kazuto Kato; Thomas M Keane; Kristina Kekesi-Lafrance; Jerome Kelleher; Giselle Kerry; Seik-Soon Khor; Bartha M Knoppers; Melissa A Konopko; Kenjiro Kosaki; Martin Kuba; Jonathan Lawson; Rasko Leinonen; Stephanie Li; Michael F Lin; Mikael Linden; Xianglin Liu; Isuru Udara Liyanage; Javier Lopez; Anneke M Lucassen; Michael Lukowski; Alice L Mann; John Marshall; Michele Mattioni; Alejandro Metke-Jimenez; Anna Middleton; Richard J Milne; Fruzsina Molnár-Gábor; Nicola Mulder; Monica C Munoz-Torres; Rishi Nag; Hidewaki Nakagawa; Jamal Nasir; Arcadi Navarro; Tristan H Nelson; Ania Niewielska; Amy Nisselle; Jeffrey Niu; Tommi H Nyrönen; Brian D O'Connor; Sabine Oesterle; Soichi Ogishima; Vivian Ota Wang; Laura A D Paglione; Emilio Palumbo; Helen E Parkinson; Anthony A Philippakis; Angel D Pizarro; Andreas Prlic; Jordi Rambla; Augusto Rendon; Renee A Rider; Peter N Robinson; Kurt W Rodarmer; Laura Lyman Rodriguez; Alan F Rubin; Manuel Rueda; Gregory A Rushton; Rosalyn S Ryan; Gary I Saunders; Helen Schuilenburg; Torsten Schwede; Serena Scollen; Alexander Senf; Nathan C Sheffield; Neerjah Skantharajah; Albert V Smith; Heidi J Sofia; Dylan Spalding; Amanda B Spurdle; Zornitza Stark; Lincoln D Stein; Makoto Suematsu; Patrick Tan; Jonathan A Tedds; Alastair A Thomson; Adrian Thorogood; Timothy L Tickle; Katsushi Tokunaga; Juha Törnroos; David Torrents; Sean Upchurch; Alfonso Valencia; Roman Valls Guimera; Jessica Vamathevan; Susheel Varma; Danya F Vears; Coby Viner; Craig Voisin; Alex H Wagner; Susan E Wallace; Brian P Walsh; Marc S Williams; Eva C Winkler; Barbara J Wold; Grant M Wood; J Patrick Woolley; Chisato Yamasaki; Andrew D Yates; Christina K Yung; Lyndon J Zass; Ksenia Zaytseva; Junjun Zhang; Peter Goodhand; Kathryn North; Ewan Birney Journal: Cell Genom Date: 2021-11-10
Authors: Jeffrey M Ashburner; Xin Wang; Xinye Li; Shaan Khurshid; Darae Ko; Ana Trisini Lipsanopoulos; Priscilla R Lee; Taylor Carmichael; Ashby C Turner; Corban Jackson; Patrick T Ellinor; Emelia J Benjamin; Steven J Atlas; Daniel E Singer; Ludovic Trinquart; Steven A Lubitz; Christopher D Anderson Journal: J Am Heart Assoc Date: 2021-10-20 Impact factor: 5.501
Authors: Shaan Khurshid; Christopher Reeder; Lia X Harrington; Pulkit Singh; Gopal Sarma; Samuel F Friedman; Paolo Di Achille; Nathaniel Diamant; Jonathan W Cunningham; Ashby C Turner; Emily S Lau; Julian S Haimovich; Mostafa A Al-Alusi; Xin Wang; Marcus D R Klarqvist; Jeffrey M Ashburner; Christian Diedrich; Mercedeh Ghadessi; Johanna Mielke; Hanna M Eilken; Alice McElhinney; Andrea Derix; Steven J Atlas; Patrick T Ellinor; Anthony A Philippakis; Christopher D Anderson; Jennifer E Ho; Puneet Batra; Steven A Lubitz Journal: NPJ Digit Med Date: 2022-04-08
Authors: Stephanie L Harrison; Deirdre A Lane; Benjamin J R Buckley; Kausik Chatterjee; Muath Alobaida; Emily Shipley; Gregory Y H Lip Journal: Vasc Health Risk Manag Date: 2022-04-26