Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident Atrial Fibrillation in a Healthy Population (From a Nationwide Danish Cohort Study)

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Abstract

A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrial fibrillation (AF), with good discrimination and internal calibration. To define high-risk patients at particular age strata for incident AF in a nationwide population cohort, who could potentially be targeted for AF screening, we used a nationwide cohort study of all Danish citizen aged ≥65 years to evaluate the performance of the C2HEST score. "High risk" subjects at age 65, 70, and 75 had 5-year risks of new onset AF of 11.8%, 14.2% and 13.6%, respectively, and the corresponding event rates were 2.99, 3.67, and 3.38 per 100 person years, respectively. Associated hazard ratios (HR) were 4.08 (95% confidence interval [CI] 3.84 to 4.34), 3.80 (95% CI: 3.68 to 3.92) and 2.17 (95% CI: 2.13 to 2.22), respectively compared with the lowest risk strata within age category. At all age cohorts, the greatest risk component of the C2HEST score on multivariable analysis was by having 2 points for C (C2), that is both CAD and COPD followed by systolic heart failure (S) both with HRs up to 2.0. CAD or COPD alone (C1) or hypertension (H) were associated with increased risk of new onset AF corresponding to HR between 1.44 and 1.64. In conclusion, this nationwide population cohort addresses the question on clinical risk prediction for new onset AF in a population at different age strata, whereby the C2HEST score may help in identifying those at 'high risk' of new onset AF at 3 distinct age cohorts (65, 70, and 75 years). A high risk C2HEST score stratum was associated with a greater risk of new onset AF. These patients could be considered for more intensive efforts for screening and detection of incident AF.

Original languageEnglish
JournalThe American Journal of Cardiology
Volume125
Issue number1
Pages (from-to)48-54
ISSN0002-9149
DOIs
Publication statusPublished - Jan 2020

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Atrial Fibrillation
Cohort Studies
Population
Chronic Obstructive Pulmonary Disease
Confidence Intervals
Systolic Heart Failure
Hypertension
Thyroid Diseases
Hyperthyroidism
Calibration

Cite this

@article{0be3f9a073864853a6fc7e0184ce110a,
title = "Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident Atrial Fibrillation in a Healthy Population (From a Nationwide Danish Cohort Study)",
abstract = "A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrial fibrillation (AF), with good discrimination and internal calibration. To define high-risk patients at particular age strata for incident AF in a nationwide population cohort, who could potentially be targeted for AF screening, we used a nationwide cohort study of all Danish citizen aged ≥65 years to evaluate the performance of the C2HEST score. {"}High risk{"} subjects at age 65, 70, and 75 had 5-year risks of new onset AF of 11.8{\%}, 14.2{\%} and 13.6{\%}, respectively, and the corresponding event rates were 2.99, 3.67, and 3.38 per 100 person years, respectively. Associated hazard ratios (HR) were 4.08 (95{\%} confidence interval [CI] 3.84 to 4.34), 3.80 (95{\%} CI: 3.68 to 3.92) and 2.17 (95{\%} CI: 2.13 to 2.22), respectively compared with the lowest risk strata within age category. At all age cohorts, the greatest risk component of the C2HEST score on multivariable analysis was by having 2 points for C (C2), that is both CAD and COPD followed by systolic heart failure (S) both with HRs up to 2.0. CAD or COPD alone (C1) or hypertension (H) were associated with increased risk of new onset AF corresponding to HR between 1.44 and 1.64. In conclusion, this nationwide population cohort addresses the question on clinical risk prediction for new onset AF in a population at different age strata, whereby the C2HEST score may help in identifying those at 'high risk' of new onset AF at 3 distinct age cohorts (65, 70, and 75 years). A high risk C2HEST score stratum was associated with a greater risk of new onset AF. These patients could be considered for more intensive efforts for screening and detection of incident AF.",
author = "Lip, {Gregory Y H} and Flemming Skj{\o}th and Nielsen, {Peter Br{\o}nnum} and Larsen, {Torben Bjerregaard}",
year = "2020",
month = "1",
doi = "10.1016/j.amjcard.2019.09.034",
language = "English",
volume = "125",
pages = "48--54",
journal = "American Journal of Cardiology",
issn = "0002-9149",
publisher = "Elsevier",
number = "1",

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TY - JOUR

T1 - Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident Atrial Fibrillation in a Healthy Population (From a Nationwide Danish Cohort Study)

AU - Lip, Gregory Y H

AU - Skjøth, Flemming

AU - Nielsen, Peter Brønnum

AU - Larsen, Torben Bjerregaard

PY - 2020/1

Y1 - 2020/1

N2 - A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrial fibrillation (AF), with good discrimination and internal calibration. To define high-risk patients at particular age strata for incident AF in a nationwide population cohort, who could potentially be targeted for AF screening, we used a nationwide cohort study of all Danish citizen aged ≥65 years to evaluate the performance of the C2HEST score. "High risk" subjects at age 65, 70, and 75 had 5-year risks of new onset AF of 11.8%, 14.2% and 13.6%, respectively, and the corresponding event rates were 2.99, 3.67, and 3.38 per 100 person years, respectively. Associated hazard ratios (HR) were 4.08 (95% confidence interval [CI] 3.84 to 4.34), 3.80 (95% CI: 3.68 to 3.92) and 2.17 (95% CI: 2.13 to 2.22), respectively compared with the lowest risk strata within age category. At all age cohorts, the greatest risk component of the C2HEST score on multivariable analysis was by having 2 points for C (C2), that is both CAD and COPD followed by systolic heart failure (S) both with HRs up to 2.0. CAD or COPD alone (C1) or hypertension (H) were associated with increased risk of new onset AF corresponding to HR between 1.44 and 1.64. In conclusion, this nationwide population cohort addresses the question on clinical risk prediction for new onset AF in a population at different age strata, whereby the C2HEST score may help in identifying those at 'high risk' of new onset AF at 3 distinct age cohorts (65, 70, and 75 years). A high risk C2HEST score stratum was associated with a greater risk of new onset AF. These patients could be considered for more intensive efforts for screening and detection of incident AF.

AB - A simple clinical score, C2HEST (C2: CAD/COPD [1 point each]; H: Hypertension; E: Elderly [Age ≥75, doubled]; S: Systolic HF [doubled]; T: Thyroid disease [hyperthyroidism]) has been proposed to predict incident atrial fibrillation (AF), with good discrimination and internal calibration. To define high-risk patients at particular age strata for incident AF in a nationwide population cohort, who could potentially be targeted for AF screening, we used a nationwide cohort study of all Danish citizen aged ≥65 years to evaluate the performance of the C2HEST score. "High risk" subjects at age 65, 70, and 75 had 5-year risks of new onset AF of 11.8%, 14.2% and 13.6%, respectively, and the corresponding event rates were 2.99, 3.67, and 3.38 per 100 person years, respectively. Associated hazard ratios (HR) were 4.08 (95% confidence interval [CI] 3.84 to 4.34), 3.80 (95% CI: 3.68 to 3.92) and 2.17 (95% CI: 2.13 to 2.22), respectively compared with the lowest risk strata within age category. At all age cohorts, the greatest risk component of the C2HEST score on multivariable analysis was by having 2 points for C (C2), that is both CAD and COPD followed by systolic heart failure (S) both with HRs up to 2.0. CAD or COPD alone (C1) or hypertension (H) were associated with increased risk of new onset AF corresponding to HR between 1.44 and 1.64. In conclusion, this nationwide population cohort addresses the question on clinical risk prediction for new onset AF in a population at different age strata, whereby the C2HEST score may help in identifying those at 'high risk' of new onset AF at 3 distinct age cohorts (65, 70, and 75 years). A high risk C2HEST score stratum was associated with a greater risk of new onset AF. These patients could be considered for more intensive efforts for screening and detection of incident AF.

U2 - 10.1016/j.amjcard.2019.09.034

DO - 10.1016/j.amjcard.2019.09.034

M3 - Journal article

C2 - 31711634

VL - 125

SP - 48

EP - 54

JO - American Journal of Cardiology

JF - American Journal of Cardiology

SN - 0002-9149

IS - 1

ER -