C2HEST score predicts clinical outcomes in heart failure with preserved ejection fraction: a secondary analysis of the TOPCAT trial

• Published in: BMC medicine 2021-02, Vol.19 (1), p.1-44, Article 44
• Main Authors: Liang, Weihao, Wu, Yuzhong, Xue, Ruicong, Wu, Zexuan, Wu, Dexi, He, Jiangui, Dong, Yugang, Lip, Gregory Y. H, Zhu, Wengen, Liu, Chen
• Format: Article
• Language: English
• Subjects: Age; Atrial fibrillation; Blood pressure; Body mass index; Cardiac arrhythmia; Cardiovascular disease; Chronic obstructive pulmonary disease; Clinical outcomes; Congestive heart failure; Continuity (mathematics); Coronary vessels; Datasets; Death; Ejection fraction; Enrollments; Function tests (Medicine); Heart failure; Heart rate; Hospitalization; Hypertension; Hyperthyroidism; Medical prognosis; Mortality; Outcomes; Patient outcomes; Patients; Practice guidelines (Medicine); Prognosis; Regression analysis; Regression models; Risk assessment; Risk prediction; Secondary analysis; Sensitivity analysis; Statistical models; Stroke
• ISSN: 1741-7015; 1741-7015
• DOI: 10.1186/s12916-021-01921-w

Background The C.sub.2HEST score has been validated for predicting AF in the general population or post-stroke patients. We aimed to assess whether this risk score could predict incident AF and other clinical outcomes in heart failure with preserved ejection fraction (HFpEF) patients. Methods A total of 2202 HFpEF patients without baseline AF in the TOPCAT trial were stratified by baseline C.sub.2HEST score. Cox proportional hazard model and competing risk regression model was used to explore the relationship between C.sub.2HEST score and outcomes, including incident AF, stroke, all-cause death, cardiovascular death, any hospitalization, and HF hospitalization. The discriminative ability of the C.sub.2HEST score for various outcomes was assessed by calculating the area under the curve (AUC). Results The incidence rates of incident AF, stroke, all-cause death, cardiovascular death, any hospitalization, and HF hospitalization were 1.79, 0.70, 3.81, 2.42, 15.50, and 3.32 per 100 person-years, respectively. When the C.sub.2HEST score was analyzed as a continuous variable, increased C.sub.2HEST score was associated with increased risk of incident AF (HR 1.50, 95% CI 1.29-1.75), as well as increased risks of all-cause death, cardiovascular death, any hospitalization, and HF hospitalization. The AUC for the C.sub.2HEST score in predicting incident AF (0.694, 95% CI 0.640-0.748) was higher than all-cause death, cardiovascular death, any hospitalization, or HF hospitalization. Conclusions The C.sub.2HEST score could predict the risk of incident AF as well as death and hospitalization with moderately good predictive abilities in patients with HFpEF. Its simplicity may allow the possibility of quick risk assessments in busy clinical settings. Keywords: Heart failure, Atrial fibrillation, Risk prediction, Outcomes