C₂HEST Score: Explanation and Clinical Context The C₂HEST Score is a validated clinical tool designed to predict the risk of incident atrial fibrillation (AF) over 5 years. It was derived from a large Asian cohort and subsequently validated in European populations. The acronym C₂HEST represents six risk factors: Coronary artery disease or Chronic heart failure (2 points), Hypertension, Elderly (age >75 years), Systolic heart failure / structural heart disease, and Thyroid disease (hyperthyroidism). Each factor is assigned 1 or 2 points, producing a total score ranging from 0 to 8.
The total score stratifies patients into four risk categories: low (0–1), intermediate (2–3), high (4–5), and very high (>6). Higher scores correlate with an increased 5-year incidence of AF, facilitating early identification of patients who may benefit from closer monitoring, lifestyle modification, or preventive interventions. The score is simple, relying on routine clinical variables, and demonstrates good discrimination (C-statistic 0.71–0.78) in multiple validation cohorts.
This tool supports clinicians in risk stratification and early management strategies for atrial fibrillation in both general and cardiovascular patient populations.
Reference:
Chao TF, Liu CJ, Tuan TC, et al. C₂HEST score for predicting incident atrial fibrillation: a large cohort study in Asia. J Am Heart Assoc. 2016;5:e003073.
Wang K, et al. Validation of the C₂HEST score in European cohorts. Europace. 2018;20:1729–1737.
Hindricks G, et al. 2020 ESC Guidelines for the diagnosis and management of atrial fibrillation. Eur Heart J. 2021;42:373–498.