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Atrial Fibrillation 2023 Update

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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

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