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Using the C2HEST Score for Predicting Postoperative Atrial Fibrillation After Cardiac Surgery: A Report From the Western Denmark Heart Registry, the Danish National Patient Registry, and the Danish National Prescription Registry.

OBJECTIVES
New-onset postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery. A targeted approach is necessary for prophylactic handling of the complication. The authors tested the performance of the C2HEST score to predict POAF in patients undergoing cardiac surgery.


DESIGN
Register-based cohort study.


SETTING
Three cardiothoracic centers.


PARTICIPANTS
All adult patients undergoing cardiac surgery in Western Denmark between January 1, 2010, and December 31, 2018, were included. Data on patient comorbidities before surgery were obtained from the Western Denmark Heart Registry, the Danish National Patient Registry, and the Danish National Prescription Registry.


INTERVENTIONS
The C2HEST score (C2: Coronary Artery Disease/Chronic Obstructive Pulmonary Disease [1 point each]; H: Hypertension; E: Elderly [Age ≥75, 2 points]; S: Systolic Heart Failure [2 points]; T: Thyroid disease [hyperthyroidism]) was calculated for each patient. The primary outcome was POAF within the primary hospital stay. The C2HEST score's discriminative ability was evaluated and compared with an age-stratified version (mC2HEST) as well as 2 validated clinical risk models (CHADS2 and CHA2DS2-VASc).


MEASUREMENTS AND MAIN RESULTS
Among the 14,279 patients included, 4,298 (30.1%) developed POAF. The C2HEST score's performance was not significantly better than the CHADS2 and CHA2DS2-VASc scores (area under the curve [AUC] 0.553 [95% confidence interval {CI} 0.543; 0.563] v 0.543 [95% CI 0.535; 0.552] and 0.565 [95% CI 0.555; 0.574], respectively). The age-modified (mC2HEST) score showed only modest improvement in the risk model, with an AUC of 0.580 (95% CI 0.570; 0.590).


CONCLUSION
The discriminative ability of the C2HEST score, measured by the AUC, was limited in this population, and was not proven to be superior to the CHADS2, CHA2DS2-VASc, and mC2HEST scores in predicting POAF after cardiac surgery.