Prediction of incident atrial fibrillation: A comprehensive evaluation of conventional and artificial intelligence-enhanced approaches.

Journal: Heart rhythm
Published Date: Aug 22, 2025

Abstract

BACKGROUND: Multiple risk scores and biomarkers have been proposed for the prediction of atrial fibrillation (AF), but it is unknown how these compare with each other and whether they could be combined. OBJECTIVE: This study aimed to evaluate and compare approaches for incident AF prediction. METHODS: The artificial intelligence-enhanced electrocardiogram risk estimator-AF (AIRE-AF), a convolutional neural network with a discrete-time survival loss function, was developed to predict incident AF. It was trained using a dataset of 1,163,401 electrocardiograms from 189,539 patients from the Beth Israel Deaconess Medical Center and externally validated in the UK Biobank (n = 38,892). AIRE-AF was compared with other risk prediction approaches including the Cohorts for Heart and Aging Research in Genomic Epidemiology (CHARGE)-AF, a clinical risk score. RESULTS: In the Beth Israel Deaconess Medical Center cohort, AIRE-AF predicted incident AF with a C-index of 0.750 (0.743-0.758). AIRE-AF was superior to CHARGE-AF, left atrial size, and N-terminal pro-B-type natriuretic peptide. The addition of CHARGE-AF and left atrial size provided a minor improvement in performance (C-index improvement 0.017). There was no additive value of N-terminal pro-B-type natriuretic peptide in combination with AIRE-AF. The single best-performing single predictor in the volunteer population (UK Biobank) was CHARGE-AF (C-index 0.750 [0.734-0.769]). The best-performing combination of 2 predictors was AIRE-AF and CHARGE-AF (C-index 0.768 [0.743-0.792]). The addition of a polygenic risk score to AIRE-AF and CHARGE-AF provided a further significant improvement in performance (C-index 0.791 [0.766-0.816]). CONCLUSION: We present the first comprehensive evaluation of methodologies for predicting incident AF. Risk prediction with a model including AIRE-AF and CHARGE-AF resulted in similar performance to more complex models.

Authors

  • Arunashis Sau
    National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK.
  • Ewa Sieliwonczyk
    National Heart and Lung Institute (A.S., K.A.M., L.P., N.B., M.G., E. Sieliwonczyk, K.P., M.A., J.Y.C., H.W., X.S., K.H., S.Z., D.B.K., N.S.P., M.M., J.S.W., F.S.N.), Imperial College London, United Kingdom.
  • Joseph Barker
  • Boroumand Zeidaabadi
    National Heart and Lung Institute, Imperial College London, London, UK.
  • Libor Pastika
    National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK.
  • Konstantinos Patlatzoglou
    National Heart and Lung Institute (A.S., K.A.M., L.P., N.B., M.G., E. Sieliwonczyk, K.P., M.A., J.Y.C., H.W., X.S., K.H., S.Z., D.B.K., N.S.P., M.M., J.S.W., F.S.N.), Imperial College London, United Kingdom.
  • Gul Rukh Khattak
    National Heart and Lung Institute, Imperial College London, London, United Kingdom.
  • Kathryn A McGurk
    National Heart and Lung Institute (A.S., K.A.M., L.P., N.B., M.G., E. Sieliwonczyk, K.P., M.A., J.Y.C., H.W., X.S., K.H., S.Z., D.B.K., N.S.P., M.M., J.S.W., F.S.N.), Imperial College London, United Kingdom.
  • Nicholas S Peters
    National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK.
  • Daniel B Kramer
    Richard A. and Susan F. Smith Center for Outcomes Research, Division of Cardiology, Beth Israel Deaconess Medical Center, Boston, Massachusetts, United States of America.
  • Jonathan W Waks
    Harvard-Thorndike Electrophysiology Institute, Beth Israel Deaconess Medical Centre, Harvard Medical School, Boston, MA, USA.
  • James S Ware
    National Heart & Lung Institute & MRC London Institute of Medical Sciences, Imperial College London, London W12 0HS, UK.
  • Fu Siong Ng
    National Heart and Lung Institute, Hammersmith Campus, Imperial College London, 72 Du Cane Road, W12 0HS, London, UK.

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