The mC2HEST Score for Incident Atrial Fibrillation: MESA (Multi-Ethnic Study of Atherosclerosis).

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.