Prediction of new-onset atrial fibrillation with the C₂HEST score in patients admitted with community-acquired pneumonia

Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The C₂HEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the C₂HEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of C₂HEST score for NOAF in patients with CAP.

Patients with CAP enrolled in the SIXTUS cohort were enrolled. C₂HEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed.

We enrolled 473 patients (36% women, mean age 70.6 ± 16.5 years), and 54 NOAF occurred. Patients with NOAF were elderly, more frequently affected by hypertension, heart failure, previous stroke/transient ischemic attack, peripheral artery disease and hyperthyroidism. NOAF patients had also higher CURB-65, PSI class and CHA₂DS₂-VASc score. The C-index of C₂HEST score for NOAF was 0.747 (95% confidence interval [95%CI] 0.705–0.786), higher compared to CURB-65 (0.611, 95%CI 0.566–0.655, p = 0.0016), PSI (0.665, 95%CI 0.621–0.708, p = 0.0199) and CHA₂DS₂-VASc score (0.696, 95%CI 0.652–0.737, p = 0.0762). The best combination of sensitivity (67%) and specificity (70%) was observed with a C₂HEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for C₂HEST score ≥ 4 was 10.7, 95%CI 2.0–57.9; p = 0.006), independently from the severity of pneumonia.

The C₂HEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP.

www.clinicaltrials.gov (NCT01773863)