30
Management
Table 7. C
2
HEST Risk Score for Detecting Incident AF*
Acronym Risk Factor Points
C
2
CAD/chronic obstructive pulmonary disease (COPD)
1–2
H Hypertension 1
E Elderly (age ≥75 y) 2
S Systolic heart failure 2
T yroid disease (hyperthyroidism) 1
* Total points 0–8. For the C
2
HEST score, the C statistic was 0.749, with 95% CI of
0.729 to 0.769. e incident rate of AF increased significantly with higher C
2
HEST
scores.
e C
2
HEST score: C
2
, coronary artery disease or chronic obstructive pulmonary
disease [1 point each]; H, hypertension [1 point]; E, elderly [age ≥75 y, 2 points]; S,
systolic HF [2 points]; T, thyroid disease [hyperthyroidism, 1 point])
4.2.1. Basic Clinical Evaluation
COR LOE
Recommendations
1 B-NR 1. In patients with newly diagnosed AF, a transthoracic
echocardiogram to assess cardiac structure, laboratory testing
to include a complete blood count, metabolic panel, and
thyroid function, and when clinical suspicion exists, targeted
testing to assess for other medical conditions associated with
AF are recommended to determine stroke and bleeding risk
factors, as well as underlying conditions that will guide further
management.
3: No
benefit
B-NR 2. In patients with newly diagnosed AF, protocolized testing for
ischemia, acute coronary syndrome (ACS), and pulmonary
embolism (PE) should not routinely be performed to assess
the etiolog y of AF unless there are additional signs or
symptoms to indicate those disorders.
4.2. Basic Evaluation