A Simple Clinical Risk Score (C 2 HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects
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 simp...
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| Vydané v: | Chest Ročník 155; číslo 3; s. 510 |
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| Hlavní autori: | , , , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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01.03.2019
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| ISSN: | 1931-3543, 1931-3543 |
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| Abstract | 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.
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).
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 C
HEST score: C
: 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 C
HEST 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 C
HEST score was superior to CHADS
and CHA
DS
-VASc scores in both cohorts in predicting incident AF.
We have developed and validated the C
HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD. |
|---|---|
| AbstractList | 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.
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).
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 C
HEST score: C
: 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 C
HEST 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 C
HEST score was superior to CHADS
and CHA
DS
-VASc scores in both cohorts in predicting incident AF.
We have developed and validated the C
HEST score as a simple clinical tool to assess the individual risk of developing AF in the Asian population without SHD. 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.BACKGROUNDThe 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.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).METHODSRisk 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).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.RESULTSIn 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.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.CONCLUSIONSWe 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. |
| Author | Pastori, Daniele Jang, Eunsun Wang, Yu-Tang Li, Yan-Guang Joung, Boyoung Farcomeni, Alessio Yang, Pil-Sung Guo, Yu-Tao Lip, Gregory Y H |
| Author_xml | – sequence: 1 givenname: Yan-Guang surname: Li fullname: Li, Yan-Guang organization: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China – sequence: 2 givenname: Daniele surname: Pastori fullname: Pastori, Daniele organization: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; I Clinica Medica, Atherothrombosis Center, Department of Internal Medicine and Medical Specialties, Sapienza University, Rome, Italy – sequence: 3 givenname: Alessio surname: Farcomeni fullname: Farcomeni, Alessio organization: Department of Public Health and Infectious Diseases, Sapienza University, Rome, Italy – sequence: 4 givenname: Pil-Sung surname: Yang fullname: Yang, Pil-Sung organization: Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea – sequence: 5 givenname: Eunsun surname: Jang fullname: Jang, Eunsun organization: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea – sequence: 6 givenname: Boyoung surname: Joung fullname: Joung, Boyoung organization: Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea – sequence: 7 givenname: Yu-Tang surname: Wang fullname: Wang, Yu-Tang organization: Department of Cardiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China – sequence: 8 givenname: Yu-Tao surname: Guo fullname: Guo, Yu-Tao organization: Department of Cardiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China – sequence: 9 givenname: Gregory Y H surname: Lip fullname: Lip, Gregory Y H email: Gregory.Lip@liverpool.ac.uk organization: Institute of Cardiovascular Sciences, University of Birmingham, Birmingham, United Kingdom; Department of Cardiology, Chinese PLA General Hospital, Chinese PLA Medical School, Beijing, China; Division of Cardiology, Department of Internal Medicine, Yonsei University Health System, Seoul, Republic of Korea; Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, United Kingdom. Electronic address: Gregory.Lip@liverpool.ac.uk |
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| SubjectTerms | Age Factors Aged Asian Continental Ancestry Group Atrial Fibrillation - diagnosis Atrial Fibrillation - ethnology Cardiovascular Diseases - epidemiology China - epidemiology Cohort Studies Comorbidity Female Humans Hyperthyroidism - epidemiology Incidence Male Prognosis Proportional Hazards Models Reproducibility of Results Republic of Korea Risk Assessment - methods Risk Assessment - statistics & numerical data Risk Factors |
| Title | A Simple Clinical Risk Score (C 2 HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects |
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