Identifying at-risk subjects for sustained atrial high-rate episodes using the C2HEST score: the West Birmingham AF project

Abstract Background Sustained atrial high-rate episodes (SAHREs) (lasting >24h) was associated with unfavorable pragnosis. Objectives To evaluate the performance of the C2HEST score in assessing individuals' risk of SAHRE. Methods The West Birminghan Atrial Fibrillation (AF) Project included 500 consecutive non-AF patients with implantable cardiac electronic device. The role of the C2HEST score for SAHRE risk stratification was evaluated. Results SAHRE was detected in 8.8% of patients (2.09%/year, 95% CI 1.47–2.71) over a mean 4.4 years of follow-up. SAHRE was associated with increased all-cause mortality (P<0.001). The risk of SAHRE increased by C2HEST score (39% higher risk per point increase). The C2HEST score had moderate predictive capability (c-index 0.706 [0.615–0.798], log-rank P=0.003) for SAHRE, which was better than other clinical scores (CHA2DS2-VASc, CHADS2, HATCH). Conclusions The C2HEST score was predictive of SAHRE, which may help to identify at-risk subjects who may need intensive device review. Central Illustration Funding Acknowledgement Type of funding source: None