Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Sep 21;44(36):3443-3452.
doi: 10.1093/eurheartj/ehad375.

New-onset atrial fibrillation prediction: the HARMS2-AF risk score

Louise Segan  1   2   3 , Rodrigo Canovas  2   4   5 , Shane Nanayakkara  1   2   6 , David Chieng  1   2   3 , Sandeep Prabhu  1   2   3 , Aleksandr Voskoboinik  1   2   3 , Hariharan Sugumar  1   2   3 , Liang-Han Ling  1   2   3 , Geoff Lee  3   7 , Joseph Morton  3   7 , Andre LaGerche  1   2   3 , David M Kaye  1   2   6 , Prashanthan Sanders  8   9 , Jonathan M Kalman  3   7 , Peter M Kistler  1   2   3   7
Affiliations

New-onset atrial fibrillation prediction: the HARMS2-AF risk score

Louise Segan et al. Eur Heart J. .

Abstract

Aims: Lifestyle risk factors are a modifiable target in atrial fibrillation (AF) management. The relative contribution of individual lifestyle risk factors to AF development has not been described. Development and validation of an AF lifestyle risk score to identify individuals at risk of AF in the general population are the aims of the study.

Methods and results: The UK Biobank (UKB) and Framingham Heart Study (FHS) are large prospective cohorts with outcomes measured >10 years. Incident AF was based on International Classification of Diseases version 10 coding. Prior AF was excluded. Cox proportional hazards regression identified independent AF predictors, which were evaluated in a multivariable model. A weighted score was developed in the UKB and externally validated in the FHS. Kaplan-Meier estimates ascertained the risk of AF development. Among 314 280 UKB participants, AF incidence was 5.7%, with median time to AF 7.6 years (interquartile range 4.5-10.2). Hypertension, age, body mass index, male sex, sleep apnoea, smoking, and alcohol were predictive variables (all P < 0.001); physical inactivity [hazard ratio (HR) 1.01, 95% confidence interval (CI) 0.96-1.05, P = 0.80] and diabetes (HR 1.03, 95% CI 0.97-1.09, P = 0·38) were not significant. The HARMS2-AF score had similar predictive performance [area under the curve (AUC) 0.782] to the unweighted model (AUC 0.802) in the UKB. External validation in the FHS (AF incidence 6.0% of 7171 participants) demonstrated an AUC of 0.757 (95% CI 0.735-0.779). A higher HARMS2-AF score (≥5 points) was associated with a heightened AF risk (score 5-9: HR 12.79; score 10-14: HR 38.70). The HARMS2-AF risk model outperformed the Framingham-AF (AUC 0.568) and ARIC (AUC 0.713) risk models (both P < 0.001) and was comparable to the CHARGE-AF risk score (AUC 0.754, P = 0.73).

Conclusion: The HARMS2-AF score is a novel lifestyle risk score which may help identify individuals at risk of AF in the general community and assist population screening.

Keywords: Alcohol; Atrial fibrillation; Lifestyle modification; Obesity; Population screening; Sleep apnoea.

PubMed Disclaimer

Comment in