Dynamic Increase of the C2HEST Score in Relation to the Development of Incident Atrial Fibrillation: A Longitudinal Cohort Study.

Background: The risk of incident atrial fibrillation (AF) increases with accumulating risk factors. Baseline-only risk assessment may not reflect the real risk of incident AF. We aimed to evaluate the performance of the dynamic change of the C₂HEST score (C2: coronary artery disease/chronic obstructive pulmonary disease (1 point each); H: hypertension (1 point); E: elderly (age ≥75 years, 2 points); S: systolic/diastolic heart failure (2 points); and T: thyroid disease (hyperthyroidism, 1 point) C₂HEST) score to assess the risk of incident AF during follow-up.

Methods: The present study data were retrieved from the Information Management and Big Data Center of Peking University Hospital Group. Patients without AF at baseline were enrolled. New-onset comorbidities were recorded during follow-up. The change in the C₂HEST score was analyzed. The baseline and the change in C₂HEST scores were compared for the prediction of incident AF.

Results: A total of 120 133 patients were included in the final analysis. During 346 400 patient-years of follow-up, 2304 developed incident AF (0.67 per 100 patient-years). The mean C₂HEST score increased significantly from 1.62 to 2.96 (P<0.05). A significant proportion of patients had newly diagnosed comorbidities (61.9% with ∆C₂HEST ≥1 in AF and 14.6% with C₂HEST ≥1 in non-AF). The change in C₂HEST scores showed better performance compared with the baseline score, as assessed by area under curve analyses (∆C₂HEST 0.821 [0.811-0.830], baseline 0.758 [0.747-0.769]), decision curve analysis, and positive net reclassification index.

Conclusions: The risk for incident AF is not static and increases with the accumulation of new comorbidities. The change in C₂HEST score had better prediction in assessing individual risk of incident AF compared with the baseline score.