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Published on: February 26, 2013
Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A
Yutao Guo1, Hao Wang1, Hui Zhang1
1Department of Cardiology, Chinese PLA General Hospital, No.28, Fuxin Road, Beijing 100853, China.
Insights
Targeted screening for atrial fibrillation (AF) using the C2HEST score, especially with symptom reporting, improves detection rates in the general population. This approach offers a pragmatic strategy for identifying individuals at high risk of developing AF.
Area of Science:
- Cardiology
- Preventive Medicine
- Digital Health
Background:
- General population screening for atrial fibrillation (AF) is advocated.
- Targeted screening of high-risk individuals presents a pragmatic alternative.
- The C2HEST score (coronary artery disease/COPD, hypertension, elderly, heart failure, hyperthyroidism) is evaluated for AF risk stratification.
Purpose of the Study:
- To assess the value of the C2HEST score for facilitating population screening and detection of incident AF.
- To compare general population screening versus targeted screening approaches for AF.
- To evaluate the predictive value of the C2HEST score and symptoms for AF detection.
Main Methods:
- Ancillary analysis of the Huawei Heart Study involving 644,124 individuals using PPG-based smart devices for pulse rhythm monitoring.
- Comparison of general vs. targeted screening approaches for AF detection.
- Analysis of cardiovascular risk factors and C2HEST score in relation to AF detection.
Main Results:
- AF detection rates increased with higher C2HEST scores and were stratified by age.
- Components of the C2HEST score showed significant hazard ratios for AF detection (1.31-2.75).
- Combining symptomatic palpitations with the C2HEST score improved AF detection prediction (c-indexes 0.72 vs. 0.76).
Conclusions:
- The C2HEST score is valuable for targeted population-based screening for AF.
- Combining the C2HEST score with patient symptoms enhances AF detection strategies.
- This approach facilitates a targeted preventive strategy for AF in the general population.
Background:
A general-population approach has been advocated to improve the screening of patients with atrial fibrillation (AF). A more pragmatic alternative may be targeted screening of patients at high risk of developing AF. We assess the value of a simple clinical risk score, C2HEST (C2, coronary artery disease/chronic obstructive pulmonary disease; COPD (1 point each); H, hypertension; E, elderly (age ≥75, doubled); S, systolic heart failure; HF (doubled); T, hyperthyroidism)); to facilitate population screening and detection of incident AF in the general population, in a prespecified ancillary analysis of the Huawei Heart Study.
Methods:
The Huawei Heart Study investigated general population screening for AF, identified using photoplethysmography (PPG)-based HUAWEI smart devices. We compared the value of a general population approach to a target screening approach between 26 October 2018 and 20 November 2019.
Results:
There were 644,124 individuals (mean age ± standard deviation, SD 34 ± 11; female 15.9%) who monitored their pulse rhythm using smart devices, among which 209,274 individuals (mean age 34 years, SD11; 10.6% female) completed the questionnaire on cardiovascular risk factors, with 739 detecting AF. Of these, 31.4% (n = 65,810) subjects reported palpitations. The median (interquartile range, IQR) duration to first detected AF was 11 (1-46), 6 (1-49), and 4 (1-24) in the population with low, intermediate, and high C2HEST score category, respectively (p = 0.03). Detected AF events rates increased with increasing C2HEST score points, stratified by age (p for trend, p < 0.001). Hazard ratios of the components of the C2HEST score for detected AF were between 1.31 and 2.75. A combination of symptomatic palpitations and C2HEST score increased prediction of AF detection, compared to using C2HEST score alone (c-indexes 0.72 vs. 0.76, Delong test, p < 0.001).
Conclusions:
The C2HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF.
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