Key result
C2HEST score predicts incident AF with ~0.75 AUC in patients without structural heart disease.
Why the study?
The incidence of atrial fibrillation is increasing in Asia, yet no risk score for predicting incident AF had been specifically developed in Asian subjects.
Does the C2HEST clinical risk score improve the prediction of incident atrial fibrillation compared to CHADS2 and CHA2DS2-VASc scores in Asian subjects without structural heart disease?
Cohort (n=922,645)
Yes
Does the C2HEST clinical risk score improve the prediction of incident atrial fibrillation compared to CHADS2 and CHA2DS2-VASc scores in Asian subjects without structural heart disease?
The C2HEST score provides a simple, validated clinical tool to assess the individual risk of developing incident atrial fibrillation in Asian populations without structural heart disease, outperforming CHADS2 and CHA2DS2-VASc scores.
Answers are grounded in this paper and cite their sources.
May support C2HEST for AF prediction in Asians; leaves open external validation before clinical use.
BACKGROUND: The incidence of atrial fibrillation (AF) is increasing, conferring a major health‐care issue in Asia. No risk score for predicting incident AF has been specifically developed in Asian subjects. Our aim was to investigate risk factors for incident AF in Asian subjects and to combine them into a simple clinical risk score. METHODS: Risk factors for incident AF were analyzed in 471,446 subjects from the Chinese Yunnan Insurance Database (internal derivation cohort) and then combined into a simple clinical risk score. External application of the new score was performed in 451,199 subjects from the Korean National Health Insurance Service (external cohort). RESULTS: In the internal cohort, structural heart disease (SHD), heart failure (HF), age ≥ 75 years, coronary artery disease (CAD), hyperthyroidism, COPD, and hypertension were associated with incident AF. Given the low prevalence and the strong association of SHD with incident AF (hazard ratio, 26.07; 95% CI, 18.22‐37.30; P < .001), these patients should be independently considered as high risk for AF and were excluded from the analysis. The remaining predictors were combined into the new simple C2HEST score: C2: CAD/COPD (1 point each); H: hypertension (1 point); E: elderly (age ≥ 75 years, 2 points); S: systolic HF (2 points); and T: thyroid disease (hyperthyroidism, 1 point). The C2HEST score showed good discrimination with the area under the curve (AUC) of 0.75 (95% CI, 0.73‐0.77) and had good calibration (P = .774). The score was internally validated by bootstrap sampling procedure, giving an AUC of 0.75 (95% CI, 0.73‐0.77). External application gave an AUC of 0.65 (95% CI, 0.65‐0.66). The C2HEST score was superior to CHADS2 and CHA2DS2‐VASc scores in both cohorts in predicting incident AF. CONCLUSIONS: We have developed and validated the C2HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD.
No takes yet. Share an insight, caveat, or question.
Li et al. (2018) conducted a cohort in Incident atrial fibrillation (n=922,645). C2HEST score (CAD, COPD, Hypertension, Elderly >=75 years, Systolic HF, Thyroid disease) vs. CHADS2 and CHA2DS2-VASc scores was evaluated on Incident atrial fibrillation (AUC 0.75, 95% CI 0.73-0.77). The C2HEST score predicted incident atrial fibrillation in Asian subjects without structural heart disease with an internal AUC of 0.75 (95% CI 0.73-0.77) and external AUC of 0.65 (95% CI 0.65-0.66).
Synapse has enriched 10 related papers. Consider them for comparative context: