Risk Assessment

Introduction of C2HEST score

With increased average global life expectancy and longer survival with chronic conditions, AF is now a global health concern. In the last 50 years, the number of individuals with AF has increased 3-fold and it is estimated that by 2050, at least 72 million individuals in Asia will be diagnosed with AF, with approximately 3 million individuals affected by AF-related strokes.1

Data from the stroke registry at Prince of Wales Hospital, Hong Kong, showed that AF-related stroke has increased by 282% over the past 15 years, accounting for approximately 28% of all strokes during this period. The data also showed that the number of AF-related strokes had the largest absolute growth in those aged ≥80 years, while the highest relative growth was seen in those aged 65–72 years (>3.5 fold).2

Several clinical risk scores have been developed to predict incident AF (eg, FHS, ARIC, CHARGE-AF scores); however, these risk scores were derived in Western populations, and a predictive score for incident AF in the Asian population has yet to be developed.3

The novel C2HEST score is a simple clinical tool to assess the individual risk of developing AF in the Asian population, and helps to identify patients without structural heart disease who are at risk of incident AF and may benefit from targeted screening programs.3 The predictive ability of the C2HEST score for incident AF has been validated in Chinese and Korean subjects,3 as well as the healthy Danish population,4 and post-stroke European patients.5 When combined with the presence of symptoms, the C2HEST score could facilitate a targeted population-based screening and preventive strategy for AF.6

AF, atrial fibrillation; ARIC, Atherosclerosis Risk in Communities Study; CHARGE-AF, Cohorts for Heart and Aging Research in Genomic Epidemiology-Atrial Fibrillation; FHS, Framingham Heart Study

Using the C2HEST calculator

The C2HEST calculator considers several risk factors, including HF, aging (≥75 years), CAD, hyperthyroidism, COPD, and hypertension – these risk factors have been demonstrated to increase the risk of incident AF.3

Table 1. C2HEST assessment calculator3


Acronym Risk factor Points   Yes No Point







Elderly (≥75 years)


Systolic HF


Thyroid disease

  Total points 0-8        

CAD, coronary artery disease; COPD, chronic obstructive pulmonary disease; HF, heart failure

Calculate Your Risk Score
  • 0–1 point:Low
  • 2–3 points:Medium
  • >3 points:High

Individuals within the high-risk C2HEST score stratum are at greater risk of new-onset AF and should be considered for more intensive efforts for screening and detection strategies.4

Figure 1. Individuals with a higher C2HEST score are at greater risk of new-onset AF3


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The information contained on this website is for informational purposes only. No material on this website is intended as a confirmation for AF diagnosis nor intended as a substitute for professional medical advice, diagnosis, or treatment. Always consult your doctor, or other qualified healthcare professionals, if you have any concerns regarding your health or medical condition.

1. Kornej J, et al. Circ Res 2020 Jun 19;127:4-20.

2. Soo Y, et al. J Neurol Neurosurg Psychiatry 2017;88:744-748.

3. Li YG, et al. Chest 2019;155:510-518.

4. Lip GYH, et al. Am J Cardiol 2020;125:48-54.

5. Li YG, et al. JAHA 2019;8:e012546.

6. Guo Y, et al. J Clin Med 2020;9:1493.

PP-ELI-HKG-1046 AUG 2022

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