PMID- 34666503
OWN - NLM
STAT- MEDLINE
DCOM- 20220303
LR  - 20220506
IS  - 2047-9980 (Electronic)
IS  - 2047-9980 (Linking)
VI  - 10
IP  - 21
DP  - 2021 Nov 2
TI  - Re-CHARGE-AF: Recalibration of the CHARGE-AF Model for Atrial Fibrillation Risk 
      Prediction in Patients With Acute Stroke.
PG  - e022363
LID - 10.1161/JAHA.121.022363 [doi]
LID - e022363
AB  - Background Performance of existing atrial fibrillation (AF) risk prediction 
      models in poststroke populations is unclear. We evaluated predictive utility of 
      an AF risk model in patients with acute stroke and assessed performance of a 
      fully refitted model. Methods and Results Within an academic hospital, we 
      included patients aged 46 to 94 years discharged for acute ischemic stroke 
      between 2003 and 2018. We estimated 5-year predicted probabilities of AF using 
      the Cohorts for Heart and Aging Research in Genomic Epidemiology for Atrial 
      Fibrillation (CHARGE-AF) model, by recalibrating CHARGE-AF to the baseline risk 
      of the sample, and by fully refitting a Cox proportional hazards model to the 
      stroke sample (Re-CHARGE-AF) model. We compared discrimination and calibration 
      between models and used 200 bootstrap samples for optimism-adjusted measures. 
      Among 551 patients with acute stroke, there were 70 incident AF events over 
      5 years (cumulative incidence, 15.2%; 95% CI, 10.6%-19.5%). Median predicted 
      5-year risk from CHARGE-AF was 4.8% (quartile 1-quartile 3, 2.0-12.6) and from 
      Re-CHARGE-AF was 16.1% (quartile 1-quartile 3, 8.0-26.2). For CHARGE-AF, 
      discrimination was moderate (C statistic, 0.64; 95% CI, 0.57-0.70) and 
      calibration was poor, underestimating AF risk (Greenwood-Nam D'Agostino 
      chi-square, P<0.001). Calibration with recalibrated baseline risk was also poor 
      (Greenwood-Nam D'Agostino chi-square, P<0.001). Re-CHARGE-AF improved 
      discrimination (P=0.001) compared with CHARGE-AF (C statistic, 0.74 [95% CI, 
      0.68-0.79]; optimism-adjusted, 0.70 [95% CI, 0.65-0.75]) and was well calibrated 
      (Greenwood-Nam D'Agostino chi-square, P=0.97). Conclusions Covariates from an 
      established AF risk model enable accurate estimation of AF risk in a poststroke 
      population after recalibration. A fully refitted model was required to account 
      for varying baseline AF hazard and strength of associations between covariates 
      and incident AF.
FAU - Ashburner, Jeffrey M
AU  - Ashburner JM
AUID- ORCID: 0000-0002-5600-3492
AD  - Division of General Internal Medicine Massachusetts General Hospital Boston MA.
AD  - Department of Medicine Harvard Medical School Boston MA.
FAU - Wang, Xin
AU  - Wang X
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
FAU - Li, Xinye
AU  - Li X
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
FAU - Khurshid, Shaan
AU  - Khurshid S
AUID- ORCID: 0000-0002-2840-4539
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
AD  - Division of Cardiology Massachusetts General Hospital Boston MA.
FAU - Ko, Darae
AU  - Ko D
AUID- ORCID: 0000-0002-1174-7535
AD  - Section of Cardiovascular Medicine Boston University School of Medicine Boston 
      MA.
FAU - Trisini Lipsanopoulos, Ana
AU  - Trisini Lipsanopoulos A
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
FAU - Lee, Priscilla R
AU  - Lee PR
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
FAU - Carmichael, Taylor
AU  - Carmichael T
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
FAU - Turner, Ashby C
AU  - Turner AC
AD  - Department of Neurology Massachusetts General Hospital & Harvard Medical School 
      Boston MA.
FAU - Jackson, Corban
AU  - Jackson C
AUID- ORCID: 0000-0002-9628-0160
AD  - Jackson Heart StudyTougaloo College Tougaloo MS.
FAU - Ellinor, Patrick T
AU  - Ellinor PT
AUID- ORCID: 0000-0002-2067-0533
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
AD  - Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA.
FAU - Benjamin, Emelia J
AU  - Benjamin EJ
AUID- ORCID: 0000-0003-4076-2336
AD  - Boston University and National HeartLung, and Blood Institute's Framingham Heart 
      Study Framingham MA.
AD  - Department of Medicine Department of Epidemiology Sections of Preventive Medicine 
      and Cardiovascular Medicine Boston University School of MedicineBoston University 
      School of Public Heath Boston MA.
FAU - Atlas, Steven J
AU  - Atlas SJ
AD  - Division of General Internal Medicine Massachusetts General Hospital Boston MA.
AD  - Department of Medicine Harvard Medical School Boston MA.
FAU - Singer, Daniel E
AU  - Singer DE
AUID- ORCID: 0000-0001-6145-4848
AD  - Division of General Internal Medicine Massachusetts General Hospital Boston MA.
AD  - Department of Medicine Harvard Medical School Boston MA.
FAU - Trinquart, Ludovic
AU  - Trinquart L
AUID- ORCID: 0000-0002-3028-4900
AD  - Boston University and National HeartLung, and Blood Institute's Framingham Heart 
      Study Framingham MA.
AD  - Department of Biostatistics Boston University School of Public Health Boston MA.
FAU - Lubitz, Steven A
AU  - Lubitz SA
AUID- ORCID: 0000-0002-9599-4866
AD  - Cardiovascular Research Center Massachusetts General Hospital Boston MA.
AD  - Cardiac Arrhythmia Service Massachusetts General Hospital Boston MA.
FAU - Anderson, Christopher D
AU  - Anderson CD
AUID- ORCID: 0000-0002-0053-2002
AD  - Department of Neurology Brigham and Women's Hospital Boston MA.
LA  - eng
GR  - K23 HL151903/HL/NHLBI NIH HHS/United States
GR  - R01 AG066914/AG/NIA NIH HHS/United States
GR  - R01 AG066010/AG/NIA NIH HHS/United States
GR  - K24 HL105780/HL/NHLBI NIH HHS/United States
GR  - U54 HL120163/HL/NHLBI NIH HHS/United States
GR  - T32 HL007208/HL/NHLBI NIH HHS/United States
GR  - U01 NS069763/NS/NINDS NIH HHS/United States
GR  - K01 HL148506/HL/NHLBI NIH HHS/United States
GR  - R01 HL092577/HL/NHLBI NIH HHS/United States
GR  - R01 NS103924/NS/NINDS NIH HHS/United States
GR  - R01 HL139731/HL/NHLBI NIH HHS/United States
GR  - R01 HL141434/HL/NHLBI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
DEP - 20211020
PL  - England
TA  - J Am Heart Assoc
JT  - Journal of the American Heart Association
JID - 101580524
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - *Atrial Fibrillation/complications/diagnosis/epidemiology
MH  - Humans
MH  - Incidence
MH  - *Ischemic Stroke
MH  - Middle Aged
MH  - Risk Assessment/methods
MH  - Risk Factors
MH  - *Stroke/diagnosis/epidemiology/etiology
PMC - PMC8751842
OTO - NOTNLM
OT  - atrial fibrillation
OT  - ischemic stroke
OT  - predicted risk
EDAT- 2021/10/21 06:00
MHDA- 2022/03/04 06:00
PMCR- 2021/11/02
CRDT- 2021/10/20 05:31
PHST- 2021/10/21 06:00 [pubmed]
PHST- 2022/03/04 06:00 [medline]
PHST- 2021/10/20 05:31 [entrez]
PHST- 2021/11/02 00:00 [pmc-release]
AID - JAH36841 [pii]
AID - 10.1161/JAHA.121.022363 [doi]
PST - ppublish
SO  - J Am Heart Assoc. 2021 Nov 2;10(21):e022363. doi: 10.1161/JAHA.121.022363. Epub 
      2021 Oct 20.