ARE YOU AT RISK FOR ATRIAL FIBRILLATION?

At my age, most of my friends and acquaintances have, or have had, Atrial Fibrillation! It is the most common arrhythmia in the world, and very interestingly, many people have it but are unaware of it. For a lot of people, it is asymptomatic, and thus it doesn’t make them feel bad. However, others, like me, are fully aware of it and know when they’re in A Fib. Those patients recognize Atrial Fib because each time they have it, the same symptoms occur. For me it’s an odd, somewhat unpleasant, feeling in my chest, and a generalized weakness that limits my physical stamina.

You are more likely to develop Atrial Fibrillation if you’re an older adult, with a history of high blood pressure and/or vascular disease, if you use tobacco products, and if you consume alcoholic beverages. A family history of A Fib increases your chance as well. While A Fib itself is rarely fatal, it leads to many problems that are—stroke, heart failure, and various other harmful conditions. 

Cardiologists are intellectually-motivated individuals who like to develop criteria that predict who in our massive general population is likely to develop Atrial Fibrillation. These criteria help them identify the tendency for A Fib early so preventive efforts can be started. There are two long-standing, reliable sets of criteria cardiologists use to determine risk scores, and they are the following:

    1. CHARGE-AF (Cohorts for Heart and Aging Research in Genomic Epidemiology)

    2. FHS-AF (Framingham Heart Study)

CHARGE-AF score employs the use of 13 predictors/criteria including an EKG. It requires a lot of data and a complex spreadsheet to determine a score and has only “fair [predictive] accuracy.”

FHS-AF score uses only 7 predictors/criteria plus an EKG. It is less cumbersome to use than CHARGE, but still has inconsistent accuracy. Both CHARGE and FHS used non-modifiable criteria which contributed to their unreliable predictability. 

Recently, a new risk score was developed that employs 7 mostly modifiable criteria. Called HARMS2-AF Its predictors are hypertension, age, raised Body Mass Index, sleep apnea, smoking, alcohol use, and unmodifiable male sex. If you have a high score, patients are able to modify/improve their risk criteria and lower their score. The exceptions are for age and sex. Scores generated are from “0” to “14.” The higher the score, the greater the risk of AFib. 

There are four (4) risk level groups which are established based on total points from the predictive factors. They are:                  10-year risk of A Fib:

     Very Low Risk Group:   0                        <1%

     Low Risk Group:        1-4                          1%

     Moderate RiskGroup: 5-9                          6%

     High Risk Group:    10-14                        18%

Another often used score is the CHA2 DS2-VASc. This score is not predictive of Atrial Fibrillation, but is used instead to predict the risk of thromboembolic disease in patients with known Atrial Fibrillation. Thus it is not pertinent to this discussion, but I wanted to mention lt.

So, if you’re a 65 yo overweight male smoker and drinker with hypertension and sleep apnea, your HARMS2-AF score is 13 or14, and you have an 18% chance of developing Atrial Fibrillation. That score seems low to me. I would bet it’s more realistically in the 40%-50% range. As I said, a lot of people have Atrial Fibrillation but just don’t realize it, so as much as these scales are predictors, they are only that, predictors. They are an educated guess and nothing more.

Plug yourself into the numeric criteria on page 554 of the reference cited to see where you stand. My score was 12. It figures because I’ve had Atrial Fibrillation for 20 years. In my case, I have a 100% risk. Twenty years ago my HARMS2-AF score would have been only 6, the Moderate risk group. I was having A Fib back then, too, so these criteria aren’t the reliable index cardiologists like to think they are. At best they are a guess. There’s more to Atrial Fibrillation than these criteria show. Just what that is is not included in any predictive scale or score. 

Reference: Ebell, MH. Assessing the Risk of Developing Atrial Fibrillation Am Fam Phys 2025 June;111(6):554-555.