A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects

Abstract

BACKGROUND: The incidence of atrial fibrillation (AF) is increasing, conferring a major health-care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects and to combine them into a simple clinical risk score. METHODS: Risk factors for incident AF were analyzed in 471,446 subjects from the Chinese Yunnan Insurance Database (internal derivation cohort) and then combined into a simple clinical risk score. External application of the new score was performed in 451,199 subjects from the Korean National Health Insurance Service (external cohort). RESULTS: In the internal cohort, structural heart disease (SHD), heart failure (HF), age $ 75 years, coronary artery disease (CAD), hyperthyroidism, COPD, and hypertension were associated with incident AF. Given the low prevalence and the strong association of SHD with incident AF (hazard ratio, 26.07; 95% CI, 18.22-37.30; P < .001), these patients should be independently considered as high risk for AF and were excluded from the analysis. The remaining predictors were combined into the new simple C 2 HEST score: C 2 : CAD/COPD (1 point each); H: hypertension (1 point); E: elderly (age $ 75 years, 2 points); S: systolic HF (2 points); and T: thyroid disease (hyperthyroidism, 1 point). The C 2 HEST score showed good discrimination with the area under the curve (AUC) of 0.75 (95% CI, 0.73-0.77) and had good calibration (P ¼ .774). The score was internally validated by bootstrap sampling procedure, giving an AUC of 0.75 (95% CI, 0.73-0.77). External application gave an AUC of 0.65 (95% CI, 0.65-0.66). The C 2 HEST score was superior to CHADS 2 and CHA 2 DS 2-VASc scores in both cohorts in predicting incident AF. CONCLUSIONS: We have developed and validated the C 2 HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD.

Prehospital Point-Of-Care Lactate Increases the Prognostic Accuracy of National Early Warning Score 2 for Early Risk Stratification of Mortality: Results of a Multicenter, Observational Study

“…None of the variables presented missing data. The statistical comparison of the cohort characteristics between groups and for each variable was performed using Student's t-test or Chi-square test when required [26].…”

“…In this way, both systems were applied to each risk group (low, low-medium, medium, and high) to determine their capability of predicting mortality, and, subsequently, their corresponding results were compared. characteristics between groups and for each variable was performed using Student's t-test or Chisquare test when required [26].…”

Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident Atrial Fibrillation in a Healthy Population (From a Nationwide Danish Cohort Study)

“…That study demonstrated that the C 2 HEST score had good discrimination with AUC 0.75 (0.73 to 0.77) and additionally good internal calibration with acceptable external validation. 8 Also, the C 2 HEST score was superior to CHADS 2 and CHA 2 DS 2 VASc scores in both cohorts in predicting incident AF. 8 A further European analysis of a hospitalbased nationwide cohort with 240,459 French postischemic stroke patients found that the C 2 HEST score had good discrimination with a C index of 0.734 (95% CI, 0.732 to 0.736), which was better than the Framingham risk score and the CHA 2 DS 2 VASc score (p <0.0001, respectively).…”

“…We recently reported a simple clinical score, C 2 HEST (C 2 : CAD/COPD (1 point each); H: Hypertension; E: Elderly (Age ≥75, doubled); S: Systolic HF (doubled); T: Thyroid disease (hyperthyroidism)), and showed good discrimination (C-statistic: 0.75) and internal calibration for incident AF. 8,9 Other more complex scores have been proposed for assessing the risk of incident AF, but many rely on detailed clinical data (e.g., ECG) which may not be immediately to hand in an opportunistic screening set up. 8,9 In a further study from an European post-stroke population, the C 2 HEST score performed well in identifying incident AF, and was significantly better than the Framingham score.…”

“…8,9 Other more complex scores have been proposed for assessing the risk of incident AF, but many rely on detailed clinical data (e.g., ECG) which may not be immediately to hand in an opportunistic screening set up. 8,9 In a further study from an European post-stroke population, the C 2 HEST score performed well in identifying incident AF, and was significantly better than the Framingham score. 10 The value of using the C 2 HEST score to help define patients at particular age strata suited for AF screening has not been previously investigated.…”