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


      • Incident atrial fibrillation is prevalent in hospital-based Chinese population.
      • The mC2HEST score had better predictive and discriminative ability for incident AF.
      • The mC2HEST score also showed moderate predictive capability for ischemic stroke.



      The C2HEST score (C2: 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.


      Risk factors for incident AF were investigated in a hospital-based population. Comparison of the C2HEST 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 C2HEST score to form a modified C2HEST score (mC2HEST). The performance of the mC2HEST score was also evaluated.


      A total of 23,523 patients entered the study with 520 developed AF during 2.84 ± 3.56 years of follow-up. 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 C2HEST score (mC2HEST). The risk of AF increased by 89% per one-point increase of the mC2HEST score. The mC2HEST score showed better predictive performance (AUC of 0.809) compared with the original C2HEST (AUC of 0.752), CHA2DS2-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 mC2HEST score had numerically higher AUC (0.849) compared with the C2HEST score (0.826) and the other scores.


      In a hospital-based Chinese population, by refining the age strata of the original C2HEST score, the mC2HEST score had significantly increased predictive accuracy and discriminative capability for incident AF. The clinical benefits of the application of novel mC2HEST score needs further validation in multiple settings.


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