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The mC2HEST Score for Incident Atrial Fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis)
Yanguang Li1, Qiaoyuan Li1, Lili Wang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
Insights
The mC2HEST score effectively predicts atrial fibrillation (AF) risk in diverse populations. This tool aids in guiding AF surveillance and screening strategies for better patient outcomes.
Area of Science:
- Cardiology
- Epidemiology
- Preventive Medicine
Background:
- Assessing individual risk for incident atrial fibrillation (AF) is crucial for developing effective preventive and screening strategies.
- The performance of the mC2HEST score in predicting incident AF, particularly in multi-ethnic populations, remains under-evaluated.
Purpose of the Study:
- To evaluate the discriminative and calibration performance of the mC2HEST score for predicting incident atrial fibrillation (AF).
- To compare the mC2HEST score's predictive accuracy against other established risk models in a multi-ethnic cohort.
Main Methods:
- Utilized data from 4,524 participants in the Multi-Ethnic Study of Atherosclerosis (MESA), aged 45-84, across diverse US communities.
- Compared the mC2HEST score's performance (discriminative and calibration) with C2HEST, HAVOC, HATCH, and CHA2DS2-VASc scores.
- Analyzed incident AF development over a mean follow-up of 13.6 years.
Main Results:
- The mC2HEST score demonstrated good predictive performance for incident AF at 10 years (C-index, 0.72) and 15 years (0.773).
- Higher mC2HEST scores correlated significantly with increased incident AF risk (log-rank P < 0.001).
- The mC2HEST score showed superior net reclassification and integrated discriminative improvement compared to other models, with optimal calibration (P = 0.41).
Conclusions:
- The mC2HEST score is a practical and validated tool for predicting incident atrial fibrillation risk.
- Its performance in a multi-ethnic population supports its use in guiding AF surveillance, resource allocation, and screening strategies.
Background:
Assessing individuals' risk of developing incident atrial fibrillation (AF) is important for making preventive and screening strategies.
Objectives:
The performance of the mC2HEST score for predicting incident AF has scarcely been evaluated, especially in a multi-ethnic population.
Methods:
Participants from the MESA (Multi-Ethnic Study of Atherosclerosis were enrolled in the present study, which involved population of different ethnicities (Caucasian, African-American, Chinese-American, and Hispanic) aged between 45 and 84 from 6 communities in the United States. The discriminative and calibration performance of the mC2HEST score was compared with other risk models.
Results:
A total of 4,524 subjects (mean age 60.2 ± 9.5 years; 53.0% female) were included; 565 (mean age 67.0 ± 7.9 years; 46.5% female) developed AF during 13.6 ± 2.5 years of follow-up, with an incidence of 0.93%/year. The mC2HEST score had good prediction at 10 years (C-index, 0.72; 95% CI: 0.701 to 0.753), and 15 years (0.773, 95% CI: 0.749 to 0.798). The risk of incident AF increased with higher mC2HEST score points and risk groups (log-rank P < 0.001). The mC2HEST score showed positive net reclassification indexes (0.057, 0.090, 0.128, and 0.143) and integrated discriminative improvement (3.2%, 3.9%, 5.7%, and 4.9%) compared with C2HEST, HAVOC, HATCH, and CHA2DS2-VASc scores, respectively. Optimal calibration was seen in the mC2HEST score (P = 0.41).
Conclusions:
The mC2HEST score is a practical model for predicting individuals' risk of incident AF that may be used for guiding AF surveillance, resource allocation, and screening strategies.
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