The C2HEST Score Assesses The Predictive Value Of The Risk Of Atrial Fibrillation And Prognosis In Patients With HFpEF

Objective: The purpose of this study was to explore the predictive value of C2 HEST score on the risk of atrial fibrillation events,heart failure rehospitalization events and all-cause death events.Methods: This study is a single center,observational and retrospective study.According to the diagnostic criteria and exclusion criteria,HFpEF patients in the first hospital of Lanzhou University from October 1,2019 to February 28,2021 were included.The final included patients were scored by C2 HEST score,and divided into low groups（0-1 points）、middle group（2-3 points）and high group（≥4 points）according to the risk of atrial fibrillation events.To compare the differences of baseline demographic data,laboratory and imaging examination between different groups,and the differences of different indicators were analyzed.According to whether HFpEF patients have atrial fibrillation events,they are divided into atrial fibrillation group and non-atrial fibrillation group.To compare the differences of baseline demographic data,laboratory and imaging examination between the two groups,and further regression analysis is performed to determine whether C2 HEST score is a relevant risk factor for HFpEF patients with atrial fibrillation events.At the same time,the incidences of atrial fibrillation events,rehospitalization events of heart failure and all-cause death events between different C2 HEST scores were compared by the ROC curve analysis.According to the area under the curve,to compare whether C2 HEST score has predictive value for new onset atrial fibrillation events,rehospitalization events of heart failure and all-cause death events in HFpEF patients.By Kaplan Meier（K-M）analysis,the risk differences of atrial fibrillation events and the survival differences of all-cause death events in HFpEF patients under different C2 HEST groups were compared.Results: A total of 215 patients with HFpEF were included in this study and divided into low group（n = 49）,medium group（n = 103）and high group（n = 63）.It was found that with the increase of C2 HEST score,they suffered from hypertension,coronary heart disease,chronic obstructive pulmonary disease,abnormal thyroid function and diabetes also showed an increasing trend（P<0.05）.HFpEF patients had atrial fibrillation events（n = 11 cases,5%）within one year of follow-up,atrial fibrillation group with the average age of patients was older,and the prevalence of coronary heart disease,chronic obstructive pulmonary disease and thyroid dysfunction were higher than non-atrial fibrillation group（P<0.05）.C2 HEST score was an independent risk factor for new onset atrial fibrillation events in patients with HFpEF（OR=3.107,P = 0.039）.In HFpEF patients,with the increase of C2 HEST score,the risk of new onset atrial fibrillation in HFPEF patients showed an increasing trend（P = 0.002）,and there was a positive correlation（r = 0.214,P = 0.002）.C2 HEST score（AUC = 0.814,95% CI = [0.699-0.929],sensitivity 73%,specificity 73%）and C2 HEST group（AUC = 0.762,95% CI = [0.639-0.884],sensitivity 73%,specificity73%）have medium predictive value for forecasting the risk of new onset atrial fibrillation events in HFPEF patients within one year.K-M curve analysis showed that the risk of short-term atrial fibrillation events increased in low,medium and high groups,and the risk of high group was significantly higher than that of low and medium groups（P<0.05）.Further study found that C2 HEST score and its group had a certain predictive ability for the incidence of rehospitalization events of heart failure（C2HEST score,AUC = 0.692;C2HEST group,AUC= 0.667）and all-cause death events（C2HEST score,AUC= 0.747;C2HEST group,AUC= 0.709）in HFpEF patients within one year.Conclusion: In HFpEF patients,the risk of atrial fibrillation events is increases with the increase of C2 HEST score.C2 HEST score have good predictive value in assessing the risk of new onset atrial fibrillation events in HFPEF patients.Meanwhile,C2 HEST score have a certain predictive value for heart failure rehospitalization events and all-cause death events in HFpEF patients.