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Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study

by Yutao Guo 1, Hao Wang 1, Hui Zhang 1, Yundai Chen 1,* and Gregory Y. H. Lip 2,3,*,†
Department of Cardiology, Chinese PLA General Hospital, No.28, Fuxin Road, Beijing 100853, China
Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, Merseyside L7 8TX, UK
Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark
Authors to whom correspondence should be addressed.
On behalf of the MAFA II investigators.
J. Clin. Med. 2020, 9(5), 1493;
Received: 5 April 2020 / Revised: 10 May 2020 / Accepted: 13 May 2020 / Published: 15 May 2020
(This article belongs to the Section Cardiology)
Background: A general-population approach has been advocated to improve the screening of patients with atrial fibrillation (AF). A more pragmatic alternative may be targeted screening of patients at high risk of developing AF. We assess the value of a simple clinical risk score, C2HEST (C2, coronary artery disease/chronic obstructive pulmonary disease; COPD (1 point each); H, hypertension; E, elderly (age ≥75, doubled); S, systolic heart failure; HF (doubled); T, hyperthyroidism)); to facilitate population screening and detection of incident AF in the general population, in a prespecified ancillary analysis of the Huawei Heart Study. Methods: The Huawei Heart Study investigated general population screening for AF, identified using photoplethysmography (PPG)-based HUAWEI smart devices. We compared the value of a general population approach to a target screening approach between 26 October 2018 and 20 November 2019. Results: There were 644,124 individuals (mean age ± standard deviation, SD 34 ± 11; female 15.9%) who monitored their pulse rhythm using smart devices, among which 209,274 individuals (mean age 34 years, SD11; 10.6% female) completed the questionnaire on cardiovascular risk factors, with 739 detecting AF. Of these, 31.4% (n = 65,810) subjects reported palpitations. The median (interquartile range, IQR) duration to first detected AF was 11 (1–46), 6 (1–49), and 4 (1–24) in the population with low, intermediate, and high C2HEST score category, respectively (p = 0.03). Detected AF events rates increased with increasing C2HEST score points, stratified by age (p for trend, p < 0.001). Hazard ratios of the components of the C2HEST score for detected AF were between 1.31 and 2.75. A combination of symptomatic palpitations and C2HEST score increased prediction of AF detection, compared to using C2HEST score alone (c-indexes 0.72 vs. 0.76, Delong test, p < 0.001). Conclusions: The C2HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF. View Full-Text
Keywords: atrial fibrillation; screening; photoplethysmography; clinical risk score atrial fibrillation; screening; photoplethysmography; clinical risk score
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Guo, Y.; Wang, H.; Zhang, H.; Chen, Y.; Lip, G.Y.H. Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study. J. Clin. Med. 2020, 9, 1493.

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