C₂HEST score for atrial fibrillation risk prediction models: a Diagnostic Accuracy Tests meta-analysis

This meta-analysis aimed to assess the value of the C₂HEST score to facilitate population screening and detection of AF risk in millions of populations and validate risk scores and their composition and discriminatory power for identifying people at high or low risk of AF. We searched major indexing databases, including Pubmed/Medline, ISI web of science, Scopus, Embase, and Cochrane central, using ("C2HEST" OR "risk scoring system" OR "risk score") AND ("atrial fibrillation (AF)" OR "atrial flutter" OR "tachycardia, supraventricular" OR "heart atrium flutter") without any language, study region or study type restrictions between 1990 and 2021 years. Analyses were done using Meta-DiSc. The title and abstract screening were conducted by two independent investigators.

Totally 679 records were found through the initial search, of which ultimately, nine articles were included in the qualitative and quantitative analyses. The risk of AF accompanied every one-point increase of C₂HEST score (OR 1.03, 95% CI 1.01-1.05, p < 0.00001), with a high heterogeneity across studies (I² = 100%). The SROC for C₂HEST score in the prediction of AF showed that the overall area under the curve (AUC) was 0.91 (95% CI 0.85-0.96), AUC in Asian population was 0.87 (95% CI: 0.78-0.95) versus non-Asian 0.95 (95% CI 0.91-0.99), and in general population was 0.92 (95% CI 0.85-0.99) versus those with chronic conditions 0.83 (95% CI 0.71-0.95), respectively.

The results of this research support the idea that this quick score has the opportunity for use as a risk assessment in patients' AF screening strategies.