ArticleCirculation. Cardiovascular quality and outcomes2023
Association Between Electrocardiographic Age and Cardiovascular Events in Community Settings: The Framingham Heart Study.
Article in Circulation. Cardiovascular quality and outcomes, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 26 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
26 citing papers in PubMed, 2 syntheses or guidelines pooled it, 35 citations in OpenAlex.
- Artificial Intelligence-Derived ECG-Age as a Predictor of Mortality and Cardiovascular Events: A Systematic Review and Meta-Analysis.Arquivos brasileiros de cardiologia · 2026Pooled it
- Artificial Intelligence Applied to Electrocardiogram-Based Cardiovascular Risk Assessment: A Systematic Review.Arquivos brasileiros de cardiologia · 2026Pooled it
- Explainable age prediction using a transformer trained on diverse global electrocardiograms.European heart journal. Digital health · 2026Article
- Development and Validation of the AI-HeartAge Model in Framingham and UK Biobank.Hypertension (Dallas, Tex. : 1979) · 2026Article
- Artificial intelligence-derived electrocardiographic age gap as a predictor of mortality after coronary revascularization: prognostic value and short-term intra-patient variability.European heart journal. Digital health · 2026Article
- Association between electrocardiographic age and cognitive function: findings from the UK biobank and Framingham Heart Study.European heart journal. Digital health · 2026Article
- Artificial intelligence-predicted ECG age gap as a biomarker: bias-adjusted correlation with mortality and cardiovascular risk factors.European heart journal. Digital health · 2026Article
- Evaluation and application of electrocardiographic age model for children.Scientific reports · 2026Article
- Longevity, Centenarians, and Lifestyle: Any ''Tips'' to Live Longer?Current nutrition reports · 2026Review
- Patterns of spironolactone management following hyperkalemia among hospitalized patients with heart failure and reduced ejection fraction: a retrospective single-center study.Frontiers in medicine · 2026Article
- AI-ECG-derived biological age as a predictor of mortality in cardiovascular and acute care patients.European heart journal. Digital health · 2025Article
- Comparison of Artificial Intelligence-Derived Heart Age with Chronological Age Using Normal Sinus Electrocardiograms in Patients with No Evidence of Cardiac Disease.Journal of clinical medicine · 2025Article
- Epigenetic age acceleration mediates the association between low-grade systemic inflammation and cardiovascular diseases: insight from the NHANES 1999-2002.Clinical epigenetics · 2025Article
- Determinants of artificial intelligence electrocardiogram-derived age and its association with cardiovascular events and mortality: a systematic review and meta-analysis.NPJ digital medicine · 2025Article
- ARID5A promotes inflammation and fibrosis during cardiac aging.Nature cardiovascular research · 2025Article
- 2025 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association.Circulation · 2025Review
- Upscaling a regional telecardiology service to a nationwide coverage and beyond: the experience of the Telehealth Network of Minas Gerais.BMJ global health · 2025Article
- Explainable AI associates ECG aging effects with increased cardiovascular risk in a longitudinal population study.NPJ digital medicine · 2025Article
- Cancer therapy-related cardiovascular aging: mechanisms, monitoring, and intervention strategies.Frontiers in cardiovascular medicine · 2025Review
- The Search Continues for Better Markers That Aid in the Diagnosis and Prevention of Atrial Fibrillation and its Complications.Arquivos brasileiros de cardiologia · 2025Article
Corrections and comments
- Commented on by
Authors and funding
13 authors at 7 institutions in 3 countries.
Funding
Abstract
backgroundDeep neural networks have been used to estimate age from ECGs, the electrocardiographic age (ECG-age), which predicts adverse outcomes. However, this prediction ability has been restricted to clinical settings or relatively short periods. We hypothesized that ECG-age is associated with death and cardiovascular outcomes in the long-standing community-based FHS (Framingham Heart Study).
methodsWe tested the association of ECG-age with chronological age in the FHS cohorts in ECGs from 1986 to 2021. We calculated the gap between chronological and ECG-age (Δage) and classified individuals as having normal, accelerated, or decelerated aging, if Δage was within, higher, or lower than the mean absolute error of the model, respectively. We assessed the associations of Δage, accelerated and decelerated aging with death or cardiovascular outcomes (atrial fibrillation, myocardial infarction, and heart failure) using Cox proportional hazards models adjusted for age, sex, and clinical factors.
resultsThe study population included 9877 FHS participants (mean age, 55±13 years; 54.9% women) with 34 948 ECGs. ECG-age was correlated to chronological age (r=0.81; mean absolute error, 9±7 years). After 17±8 years of follow-up, every 10-year increase of Δage was associated with 18% increase in all-cause mortality (hazard ratio [HR], 1.18 [95% CI, 1.12-1.23]), 23% increase in atrial fibrillation risk (HR, 1.23 [95% CI, 1.17-1.29]), 14% increase in myocardial infarction risk (HR, 1.14 [95% CI, 1.05-1.23]), and 40% increase in heart failure risk (HR, 1.40 [95% CI, 1.30-1.52]), in multivariable models. In addition, accelerated aging was associated with a 28% increase in all-cause mortality (HR, 1.28 [95% CI, 1.14-1.45]), whereas decelerated aging was associated with a 16% decrease (HR, 0.84 [95% CI, 0.74-0.95]).
conclusionsECG-age was highly correlated with chronological age in FHS. The difference between ECG-age and chronological age was associated with death, myocardial infarction, atrial fibrillation, and heart failure. Given the wide availability and low cost of ECG, ECG-age could be a scalable biomarker of cardiovascular risk.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.