Observational studyRespiratory research2025
Enhancing atrial fibrillation risk prediction in an observational cohort of tobacco-exposed individuals: the role of pulmonary function tests, symptom scores, and imaging.
Observational study in Respiratory research, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
introductionCOPD is associated with an increased AFib-related morbidity and mortality. There are several AFib risk prediction models available, but none have been validated in the COPD population. Our study aims to identify spirometric and radiographic variables that are associated with an increased risk of AFib. Secondarily, we hope to determine if these associated variables improve the risk discrimination of established AFib risk prediction models in individuals with COPD.
methodsWe evaluated 755 participants from a single center tobacco-exposed cohort at baseline. At this study visit, the following were performed: demographic, medical history, and symptom questionnaires, PFT, and CT imaging. We performed logistic regression analysis to determine cardiopulmonary variables associated with prevalent AFib. The multivariable analysis was adjusted for sex, age, number of pack years, BMI, self-reported heart failure, and anti-hypertensive medication use. Exposure variables that were statistically significant in the logistic regression analysis were added in succession to current AFib risk prediction models, CHA2DS2-VASc and CHARGE-AF, to create updated models. C-statistics were calculated for both risk scores alone as well as with each updated model.
resultsDLco (OR 0.40, CI 0.18–0.86), heart volume (OR 13.12, CI 2.32–74.17), percentage of emphysema (OR 2.77, CI 1.04–7.40), and mMRC (OR 1.17, CI 1.02–1.35) were associated with prevalent AFib in the multivariable logistic regression analysis. When conducting the discrimination analysis of the AFib risk prediction scores, the addition of these cardiopulmonary variables improved CHARGE-AF, from C-statistic 0.53 to 0.63 (p < 0.03).
conclusionsWe identified cardiopulmonary factors associated with an increased risk of AFib in a tobacco-exposed cohort. The incorporation of lung function, CT parameters, and symptom scores in validated AFib prediction models may improve AFib risk discrimination in our chronic lung disease populations. CLINICAL TRIAL NUMBER: not applicable.
trial registrationThis study was supported by the National Institute of Health (NIH) National Heart, Lung and Blood Institute (NHLBI) grants 1R01HL128289 (J.B.) and P50HL084948 (F.C.S.).
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