{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,24]],"date-time":"2026-09-24T21:56:30Z","timestamp":1790286990663,"version":"4.1.0"},"reference-count":57,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"10","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Arrhythmia and Electrophysiology"],"published-print":{"date-parts":[[2025,10]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND:<\/jats:title>\n                    <jats:p>We aimed to refine and validate a deep neural network model from the ECG to predict atrial fibrillation (AF) risk, using samples from diverse backgrounds: the Framingham Heart Study (FHS), UK Biobank, and Estudo Longitudinal da Sa\u00fade do Adulto (ELSA-Brasil). We compared the model\u2019s performance to the clinical Cohorts for Heart and Aging Research in Genomic Epidemiology consortium (CHARGE-AF) risk score and evaluated the association with other cardiovascular outcomes.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS:<\/jats:title>\n                    <jats:p>The ECG-derived deep-learning prediction of AF (ECG-AF) model was refined using 60% of FHS samples free of AF. Its performance was then tested in the remaining FHS samples, UK Biobank, and ELSA-Brasil, with discrimination assessed by the area under the receiver operating characteristic curve. The association of ECG-AF with cardiovascular outcomes was assessed using Cox proportional hazards models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS:<\/jats:title>\n                    <jats:p>The study sample included 10\u2009097 FHS participants (mean age 53\u00b112 years; 54.9% women), 49\u2009280 participants from the UK Biobank (mean age 64\u00b18 years, 47.9% women), and 12\u2009284 participants from ELSA-Brasil (mean age 53\u00b18 years, 54.7% women). The ECG-AF model showed moderate discrimination for incident AF (area under the curve, 0.82 [95% CI, 0.80\u20130.84]) in the FHS, comparable to the CHARGE-AF score (area under the curve, 0.83 [95% CI, 0.81\u20130.85]), and incremental when combined (area under the curve, 0.85 [95% CI, 0.83\u20130.87]). In UK Biobank and ELSA-Brasil, combining ECG-AF and CHARGE also improved prediction. Higher ECG-AF scores were associated with increased risks of heart failure, myocardial infarction, stroke, and all-cause mortality in all 3 cohorts.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS:<\/jats:title>\n                    <jats:p>In multinational cohort studies, the single-input ECG-AF deep neural network model demonstrated good performance in predicting AF and other cardiovascular outcomes, comparable to a multivariable clinical risk score, with improved performance when combined.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/circep.125.013734","type":"journal-article","created":{"date-parts":[[2025,9,30]],"date-time":"2025-09-30T09:00:34Z","timestamp":1759222834000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Prediction of Atrial Fibrillation From the ECG in the Community Using Deep Learning: A Multinational Study"],"prefix":"10.1161","volume":"18","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7317-1367","authenticated-orcid":true,"given":"Luisa C.C.","family":"Brant","sequence":"first","affiliation":[{"name":"Faculty of Medicine &amp; Hospital das Cl\u00ednicas\/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.C.B., S.M.B., A.L.P.R.)."},{"name":"Telehealth Center, Hospital das Cl\u00ednicas\/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.C.B., M.M.P.-F., A.L.P.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3632-8529","authenticated-orcid":true,"given":"Ant\u00f4nio H.","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Department of Information Technology, Uppsala University, Sweden (A.H.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oseiwe B.","family":"Eromosele","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (O.B.E., E.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6646-1163","authenticated-orcid":true,"given":"Marcelo M.","family":"Pinto-Filho","sequence":"additional","affiliation":[{"name":"Telehealth Center, Hospital das Cl\u00ednicas\/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.C.B., M.M.P.-F., A.L.P.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7383-7811","authenticated-orcid":true,"given":"Sandhi M.","family":"Barreto","sequence":"additional","affiliation":[{"name":"Faculty of Medicine &amp; Hospital das Cl\u00ednicas\/EBSERH, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil (L.C.C.B., S.M.B., A.L.P.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7491-2630","authenticated-orcid":true,"given":"Bruce B.","family":"Duncan","sequence":"additional","affiliation":[{"name":"Postgraduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil (B.B.D.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9631-1254","authenticated-orcid":true,"given":"Martin G.","family":"Larson","sequence":"additional","affiliation":[{"name":"Department of Biostatistics (M.G.L.), Boston University School of Public Health, MA."},{"name":"National Heart, Lung, and Blood Institute and Boston University\u2019s Framingham Heart Study, MA (M.G.L., E.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4076-2336","authenticated-orcid":true,"given":"Emelia J.","family":"Benjamin","sequence":"additional","affiliation":[{"name":"Section of Cardiovascular Medicine, Boston Medical Center, Boston University Chobanian and Avedisian School of Medicine, MA (O.B.E., E.J.B.)."},{"name":"Department of Epidemiology (E.J.B.), Boston University School of Public Health, MA."},{"name":"National Heart, Lung, and Blood Institute and Boston University\u2019s Framingham Heart Study, MA (M.G.L., E.J.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2740-0042","authenticated-orcid":true,"given":"Antonio L.P.","family":"Ribeiro","sequence":"additional","affiliation":[{"name":"Faculty of Medicine &amp; 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