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.