Prediction of new-onset atrial fibrillation with the C 2 HEST score in patients admitted with community-acquired pneumonia.

PURPOSE: Patients hospitalized for community-acquired pneumonia (CAP) may have a higher risk of new-onset atrial fibrillation (NOAF). The C2 HEST score was developed to evaluate the NOAF risk in the general population. Data on the value of the C2 HEST score in acute patients admitted with CAP are lacking. We want to establish the predictive value of C2 HEST score for NOAF in patients with CAP.

METHODS: Patients with CAP enrolled in the SIXTUS cohort were enrolled. C2 HEST score was calculated at baseline. In-hospital NOAF was recorded. Receiver-operating Characteristic (ROC) curve and multivariable Cox proportional hazard regression analysis were performed.

RESULTS: 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 CHA2 DS2 -VASc score. The C-index of C2 HEST 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 CHA2 DS2 -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 C2 HEST score ≥ 4. This result was confirmed by the multivariable Cox analysis (Hazard Ratio [HR] for C2 HEST score ≥ 4 was 10.7, 95%CI 2.0-57.9; p = 0.006), independently from the severity of pneumonia.

CONCLUSION: The C2 HEST score was a useful predictive tool to identify patients at higher risk for NOAF during hospitalization for CAP.

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CLINICALTRIALS: gov (NCT01773863).