Abstract
Background
The Framingham Heart Study Dementia Risk Score (FDRS) was developed in a general population
of older persons. It is unknown how the FDRS variables predict Alzheimer's disease
and Alzheimer's disease-related dementias (AD/ADRD) in heart failure and atrial fibrillation
populations. We aimed to evaluate the predictive ability of the FDRS variables in
population-based cohorts of heart failure and atrial fibrillation and to determine
whether the addition of other comorbidities and risk factors improves risk prediction
for AD/ADRD.
Methods
Residents aged ≥50 years from 7 southeastern Minnesota counties with a first diagnosis
of heart failure or atrial fibrillation between January 1, 2013, and December 31,
2017, were identified. Patients with AD/ADRD before or within 6 months after index
atrial fibrillation or heart failure and patients who died within 6 months after index
were excluded. For both cohorts, models were constructed to predict AD/ADRD after
index including the variables in the FDRS. Additional comorbidities and risk factors
were added to the models. For all models, c-statistics using 5-fold cross-validation
were calculated.
Results
Among 3052 patients with heart failure (mean age 75 years, 53% male), 626 developed
AD/ADRD; among 4107 patients with atrial fibrillation (mean age 74 years, 57% male),
736 developed AD/ADRD. Among patients with heart failure, the FDRS variables predicted
AD/ADRD with c-statistic = 0.69. Adding comorbidities and risk factors improved the
c-statistic slightly to 0.70. The FDRS variables also performed well (c-statistic = 0.73)
in patients with atrial fibrillation; adding comorbidities and risk factors slightly
improved performance (c-statistic = 0.75).
Conclusions
The variables from the FDRS predict AD/ADRD well in both heart failure and atrial
fibrillation populations. The addition of comorbidities and risk factors only modestly
improved prediction, indicating that the FDRS variables are appropriate to predict
AD/ADRD in patients with heart failure and atrial fibrillation.
Keywords
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References
- Prevalence of diagnosed atrial fibrillation in adults: national implications for rhythm management and stroke prevention: the AnTicoagulation and Risk Factors in Atrial Fibrillation (ATRIA) Study.JAMA. 2001; 285: 2370-2375
- Heart disease and stroke statistics-2021 update: a report from the American Heart Association.Circulation. 2021; 143: e254-e743
- Heart failure and cognitive impairment in the atherosclerosis risk in communities (ARIC) study.J Gen Intern Med. 2018; 33: 1721-1728
- Heart failure and risk of dementia and Alzheimer disease: a population-based cohort study.Arch Intern Med. 2006; 166: 1003-1008
- Cardiovascular disease and cognitive decline in postmenopausal women: results from the women's health initiative memory study.J Am Heart Assoc. 2013; 2e000369
- Incidence of dementia: evidence for an effect modification by gender. The ILSA Study.Int Psychogeriatr. 2013; 25: 1867-1876
- Heart diseases and long-term risk of dementia and Alzheimer's disease: a population-based CAIDE study.J Alzheimers Dis. 2014; 42: 183-191
- Heart failure and risk of dementia: a Danish nationwide population-based cohort study.Eur J Heart Fail. 2017; 19: 253-260
- Cognitive impairment associated with atrial fibrillation: a meta-analysis.Ann Intern Med. 2013; 158: 338-346
- Risk of dementia in stroke-free patients diagnosed with atrial fibrillation: data from a community-based cohort.Eur Heart J. 2007; 28: 1962-1967
- 2022 Alzheimer's disease facts and figures.Alzheimers Dement. 2022; 18: 700-789
- Practical risk score for 5-, 10-, and 20-year prediction of dementia in elderly persons: Framingham Heart Study.Alzheimers Dement. 2018; 14: 35-42
- Data resource profile: expansion of the Rochester Epidemiology Project medical records-linkage system (E-REP).Int J Epidemiol. 2018; 47 (368-368j)
- History of the Rochester Epidemiology Project: half a century of medical records linkage in a US population.Mayo Clin Proc. 2012; 87: 1202-1213
- Generalizability of epidemiological findings and public health decisions: an illustration from the Rochester Epidemiology Project.Mayo Clin Proc. 2012; 87: 151-160
- Identifying heart failure using EMR-based algorithms.Int J Med Inform. 2018; : 1-7
- Longitudinal cohorts for harnessing the electronic health record for disease prediction in a US population.BMJ Open. 2021; 11e044353
- Body mass index and all-cause mortality among older adults.Obesity (Silver Spring). 2016; 24: 2232-2239
- Defining and measuring chronic conditions: imperatives for research, policy, program, and practice.Prev Chronic Dis. 2013; 10E66
US Department of Health and Human Services. Multiple chronic conditions - a strategic framework: optimum health and quality of life for individuals with multiple chronic conditions. Available at:https://www.hhs.gov/sites/default/files/ash/initiatives/mcc/mcc_framework.pdf. Accessed May 7, 2021.
Centers for Medicare and Medicaid Chronic Conditions Data Warehouse (CCW). CCW Condition Algorithms. Available at: https://www.ccwdata.org/web/guest/condition-categories. Accessed May 7, 2021.
- The accuracy of Medicare claims data in identifying Alzheimer's disease.J Clin Epidemiol. 2002; 55: 929-937
- Assessing calibration of prognostic risk scores.Stat Methods Med Res. 2016; 25: 1692-1706
- Alzheimer's disease and related dementias and heart failure: a community study.J Am Geriatr Soc. 2022; 70: 1664-1672
- Development and Validation of eRADAR: a tool using EHR data to detect unrecognized dementia.J Am Geriatr Soc. 2020; 68: 103-111
- 2019 Alzheimer's disease facts and figures.Alzheimers Dement. 2019; 15: 321-387
- Missed and delayed diagnosis of dementia in primary care: prevalence and contributing factors.Alzheimer Dis Assoc Disord. 2009; 23: 306-314
- Passive case-finding for Alzheimer's disease and dementia in two U.S. communities.Alzheimers Dement. 2011; 7: 53-60
Article info
Publication history
Published online: December 07, 2022
Publication stage
In Press Journal Pre-ProofFootnotes
Funding: This work was supported by the National Institute on Aging (R21 AG064804) and used the resources of the Rochester Epidemiology Project (REP) medical records-linkage system, which is supported by the National Institute on Aging (NIA; AG058738), by the Mayo Clinic Research Committee, and by fees paid annually by REP users. The content of this article is solely the responsibility of the authors and does not represent the official views of the National Institutes of Health (NIH) or the Mayo Clinic. The funding sources played no role in the design, conduct, or reporting of this study.
Conflicts of Interest: None.
Authorship: All authors had access to the data and a role in writing this manuscript.
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