C(2)HEST score predicts clinical outcomes in heart failure with preserved ejection fraction: a secondary analysis of the TOPCAT trial

BACKGROUND: The C(2)HEST score has been validated for predicting AF in the general population or post-stroke patients. We aimed to assess whether this risk score could predict incident AF and other clinical outcomes in heart failure with preserved ejection fraction (HFpEF) patients. METHODS: A total of 2202 HFpEF patients without baseline AF in the TOPCAT trial were stratified by baseline C(2)HEST score. Cox proportional hazard model and competing risk regression model was used to explore the relationship between C(2)HEST score and outcomes, including incident AF, stroke, all-cause death, cardiovascular death, any hospitalization, and HF hospitalization. The discriminative ability of the C(2)HEST score for various outcomes was assessed by calculating the area under the curve (AUC). RESULTS: The incidence rates of incident AF, stroke, all-cause death, cardiovascular death, any hospitalization, and HF hospitalization were 1.79, 0.70, 3.81, 2.42, 15.50, and 3.32 per 100 person-years, respectively. When the C(2)HEST score was analyzed as a continuous variable, increased C(2)HEST score was associated with increased risk of incident AF (HR 1.50, 95% CI 1.29–1.75), as well as increased risks of all-cause death, cardiovascular death, any hospitalization, and HF hospitalization. The AUC for the C(2)HEST score in predicting incident AF (0.694, 95% CI 0.640–0.748) was higher than all-cause death, cardiovascular death, any hospitalization, or HF hospitalization. CONCLUSIONS: The C(2)HEST score could predict the risk of incident AF as well as death and hospitalization with moderately good predictive abilities in patients with HFpEF. Its simplicity may allow the possibility of quick risk assessments in busy clinical settings. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12916-021-01921-w.