Key result
The C2HEST score predicted sustained atrial high-rate episodes in patients with cardiac implantable devices (AUC 0.73; 95% CI 0.64-0.81), with a 3.62% annual incidence for scores ≥4.
Why the study?
Sustained atrial high-rate episodes (SAHREs) in patients with cardiac implantable electronic devices carry adverse outcomes, but risk stratification for developing SAHREs had never been investigated.
Does the C2HEST score predict the development of sustained atrial high-rate episodes in patients with cardiac implantable electronic devices without atrial fibrillation?
Cohort (n=500)
Does the C2HEST score predict the development of sustained atrial high-rate episodes in patients with cardiac implantable electronic devices without atrial fibrillation?
Effect estimate: AUC 0.73 (95% CI 0.64-0.81)
p-value: p=0.003
The C2HEST score demonstrates moderate predictive capability for identifying patients with cardiac implantable electronic devices at risk of developing sustained atrial high-rate episodes.
May support C2HEST for atrial high-rate episode risk stratification in device patients; leaves open impact on management or outcomes.
Background Sustained atrial high‐rate episodes (SAHREs) among individuals with a cardiac implantable electronic device are associated with an increased risk of adverse outcomes. Risk stratification for the development of SAHREs has never been investigated. We aimed to assess the performance of the C 2 HEST (coronary artery disease or chronic obstructive pulmonary disease [1 point each], hypertension [1 point], elderly [age ≥75 years, 2 points], systolic heart failure [2 points], thyroid disease [1 point]) score in predicting SAHREs in patients with cardiac implantable electronic devices without atrial fibrillation. Methods and Results Five Hundred consecutive patients with cardiac implantable electronic devices in the West Birmingham Atrial Fibrillation Project in the United Kingdom were followed since the procedure to observe the development of SAHREs, defined by atrial high‐rate episodes lasting >24 hours. Risk factors and incidence of SAHREs were analyzed. The predictive value of the C 2 HEST score for SAHRE prediction was evaluated. Over a mean follow‐up of 53.1 months, 44 (8.8%) patients developed SAHREs. SAHREs were associated with higher all‐cause mortality ( P <0.001) and ischemic stroke ( P =0.001). Age and heart failure were associated with SAHRE occurrence. The incidence of SAHREs increased by the C 2 HEST score (39% higher risk per point increase). Among patients with a C 2 HEST score ≥4, the incidence of SAHREs was 3.62% per year (95% CI, 2.14–5.16). The C 2 HEST score had moderate predictive capability (area under the curve, 0.73; 95% CI, 0.64–0.81) and discriminative ability (log‐rank P =0.003), which was better than other clinical scores (CHA 2 DS 2 ‐VASc, CHADS 2 , HATCH). Conclusions The C 2 HEST score predicted SAHRE incidence in patients without atrial fibrillation who had an cardiac implantable electronic device, with the highest risk seen in patients with a C 2 HEST score ≥4 The benefit of using the C 2 HEST score in clinical practice in this patient population needs further investigation.
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Li et al. (2021) conducted a cohort in Cardiac implantable electronic devices without atrial fibrillation (n=500). C2HEST score vs. Lower C2HEST scores was evaluated on Sustained atrial high-rate episodes (SAHREs) lasting >24 hours (AUC 0.73, 95% CI 0.64-0.81, p=0.003). The C2HEST score predicted sustained atrial high-rate episodes in patients with cardiac implantable devices (AUC 0.73; 95% CI 0.64-0.81), with a 3.62% annual incidence for scores ≥4.
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