Refining age stratum of the C 2 HEST score for predicting incident atrial fibrillation in a hospital-based Chinese population

• Published in: European journal of internal medicine 2021-05
• Main Authors: Li, Yan-Guang, Bai, Jin, Zhou, Gongbu, Li, Juan, Wei, Yi, Sun, Lijie, Zu, Lingyun, Liu, Shuwang
• Format: Article
• Language: English
• ISSN: 1879-0828
• DOI: 10.1016/j.ejim.2021.04.014

The C HEST score (C : 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 C 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 HEST score to form a modified C HEST score (mC HEST). The performance of the mC HEST 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 C HEST score (mC HEST). The risk of AF increased by 89% per one-point increase of the mC HEST score. The mC HEST score showed better predictive performance (AUC of 0.809) compared with the original C HEST (AUC of 0.752), CHA DS -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 HEST score had numerically higher AUC (0.849) compared with the C HEST score (0.826) and the other scores. In a hospital-based Chinese population, by refining the age strata of the original C HEST score, the mC HEST score had significantly increased predictive accuracy and discriminative capability for incident AF. The clinical benefits of the application of novel mC HEST score needs further validation in multiple settings.