Refining age stratum of the C2HEST score for predicting incident atrial fibrillation in a hospital-based Chinese population

Abstract

Background:The C 2 HEST score (C 2 : coronary artery disease [CAD] / chronic obstructive pulmonary disease [COPD] (1 point each); H: Hypertension; E: Elderly (Age≥75, doubled); S: Systolic heart failure (doubled); T: Thyroid disease (hyperthyroidism)) has been validated to predict incident atrial fibrillation (AF). Its performance in the hospital-based Chinese population has never been evaluated. Methods: Risk factors for incident AF were investigated in a hospital-based population. Comparison of the C 2 HEST score and other clinical scores with the capacity of predicting incident AF was conducted using area under the curves (AUC), net reclassification index (NRI), integrated discriminative improvement (IDI), and decision curve analysis (DCA). An age-stratified criterion was used to refine the C 2 HEST score to form a modified C 2 HEST score (mC 2 HEST). The performance of the mC 2 HEST score was also evaluated. Results: A total of 23,523 patients entered the study with 520 developed AF during 2.84 ± 3.56 years of followup. Risk factors for incident AF included age, male sex, hypertension, CAD, COPD, previous ischemic stroke, hyperthyroidism, and heart failure. Age ≥65 years has significantly increased the risk of AF, which was considered as the age cutoff for a modified C 2 HEST score (mC 2 HEST). The risk of AF increased by 89% per onepoint increase of the mC 2 HEST score. The mC 2 HEST score showed better predictive performance (AUC of 0.809) compared with the original C 2 HEST (AUC of 0.752), CHA 2 DS 2 -VASc (0.756), HATCH (0.722), and HAVOC (0.758) scores, also as estimated by IDI, NRI and DCA. Among those enrolled after 2012, the mC 2 HEST score had numerically higher AUC (0.849) compared with the C 2 HEST score (0.826) and the other scores. Conclusion:In a hospital-based Chinese population, by refining the age strata of the original C 2 HEST score, the mC 2 HEST score had significantly increased predictive accuracy and discriminative capability for incident AF. The clinical benefits of the application of novel mC 2 HEST score needs further validation in multiple settings.

Predicting Late Recurrence of Atrial Fibrillation After Radiofrequency Ablation in Patients With Atrial Fibrillation: Comparison of C2HEST and HATCH Scores

“…Patients ≥ 75 years of age are at increased risk of recurrence. In a recent study by Li et al it was found that the modified mC2HEST score (with age ≥ 65 years added as 1 point) increased the predictive power for atrial fibrillation ( 28 ). However, from our results, this was not observed for postoperative recurrence of AF.…”

HATCH Score and Left Atrial Size Predict Atrial High-Rate Episodes in Patients With Cardiac Implantable Electronic Devices

“…We found also that the percentage of AHRE ≥3 min increased with increasing HATCH score. Recently, Li et al ( 19 ), in China, modified the mC 2 HEST score (adding age ≥65 years as one point), which increased the predictive accuracy and discriminative capability for incident AF. We also evaluated the performance of the mC 2 HEST score but found it not as suitable as the HATCH score (data not shown).…”

The performance of five models compared with atrial high rate episodes predicts new atrial fibrillation after cardiac implantable electronic devices implantation

“…Atrial fibrillation (AF) is a leading arrhythmia worldwide and the major risk of systemic thromboembolic events (Hindricks et al, 2021 ; January et al, 2019 ). Several predicting models, including CHA 2 DS 2 ‐VASc score (Hu & Lin, 2018 ; Zuo et al, 2013 ), C 2 HEST score (Li, Bisson, et al, 2019 ; Li, Pastori, et al, 2019 ; Lip et al, 2020 ), mCHEST score (Li, Bai, et al, 2021 ), HAT 2 CH 2 score (Emren et al, 2016 ; Hu & Lin, 2017 ), and HAVOC score (Ntaios et al, 2020 ; Zhao et al, 2019 ) have been elucidated for predicting new AF in different populations and all revealed acceptable discriminating power. A prospective study enrolled 528 symptomatic arrhythmic patients and showed a CHA 2 DS 2 ‐VASc score with a C statistic 0.63 and an optimal cutoff at 2 for new‐onset AF (Zuo et al, 2013 ).…”

“…C 2 HEST score was used to predict new AF in a Danish Healthy Population (Lip et al, 2020 ), post‐stroke patients from France, (Li, Bisson, et al, 2019 ) and Chinese and Korean subjects (Li, Pastori, et al, 2019 ). The mCHEST score was refined in a hospital‐based Chinese population and showed better predictive performance than other predicting models for incident AF (Li, Bai, et al, 2021 ). HAT 2 CH 2 score has a slightly but significantly better predictive performance than CHA 2 DS 2 ‐VASc score for new AF in cancer patients (Hu & Lin, 2017 ), and can be used to predict the development of AF in patients after coronary artery bypass surgery (Emren et al, 2016 ).…”