Department of Clinical Internal, Anesthesiological, and Cardiovascular Sciences, Sapienza University of Rome, Rome, Italy.
Liverpool Centre for Cardiovascular Science at University of Liverpool, Liverpool John Moores University, Liverpool Heart and Chest Hospital, Liverpool, UK.
Eur J Clin Invest. 2024 Nov;54(11):e14293. doi: 10.1111/eci.14293. Epub 2024 Jul 27.
The incidence of new-onset atrial fibrillation (NOAF) is increasing in the last decades. NOAF is associated with worse long-term prognosis. The CHEST score has been recently proposed to stratify the risk of NOAF. Pooled data on the performance of the CHEST score are lacking.
Systematic review and meta-analysis of observational studies reporting data on NOAF according to the CHEST score. We searched PubMed, Web of Science and Google scholar databases without time restrictions until June 2023 according to PRISMA guidelines. Meta-analysis of the area under the curve (AUC) with 95% confidence interval (95% CI) and a sensitivity analysis according to setting of care and countries were performed.
Of 360 studies, 17 were included in the analysis accounting for 11,067,496 subjects/patients with 307,869 NOAF cases. Mean age ranged from 41.3 to 71.2 years. The prevalence of women ranged from 10.6 to 54.75%. The pooled analysis gave an AUC of .70 (95% CI .66-.74). A subgroup analysis on studies from general population/primary care yielded an AUC of 0.69 (95% CI 0.64-0.75). In the subgroup of patients with cardiovascular disease, the AUC was .71 (.69-.79). The CHEST score performed similarly in Asian (AUC .72, 95% CI .68-.77), and in Western patients (AUC .68, 95% CI .62-.75). The best performance was observed in studies with a mean age <50 years (n = 3,144,704 with 25,538 NOAF, AUC .78, 95% CI .76-.79).
The CHEST score may be used to predict NOAF in primary and secondary prevention patients, and in patients across different countries. Early detection of NOAF may aid prompt initiation of management and follow-up, potentially leading to a reduction of AF-related complications.
新发心房颤动（NOAF）的发病率在过去几十年中不断增加。NOAF 与更差的长期预后相关。CHEST 评分最近被提出用于分层 NOAF 的风险。关于 CHEST 评分表现的汇总数据尚缺乏。
系统检索并分析了根据 CHEST 评分报告 NOAF 数据的观察性研究的文献。我们根据 PRISMA 指南，无时间限制地检索了 PubMed、Web of Science 和 Google Scholar 数据库，检索截止日期为 2023 年 6 月。采用 95%置信区间（95%CI）和根据护理设置和国家进行的敏感性分析对曲线下面积（AUC）进行了荟萃分析。
在 360 项研究中，有 17 项研究纳入了分析，共纳入了 11067496 例患者，其中 307869 例发生了 NOAF。平均年龄范围为 41.3 至 71.2 岁。女性的比例范围为 10.6%至 54.75%。汇总分析的 AUC 为 0.70（95%CI 0.66-0.74）。来自一般人群/初级保健的研究的亚组分析得出的 AUC 为 0.69（95%CI 0.64-0.75）。在心血管疾病患者亚组中，AUC 为 0.71（0.69-0.79）。CHEST 评分在亚洲患者（AUC 0.72，95%CI 0.68-0.77）和西方患者中表现相似（AUC 0.68，95%CI 0.62-0.75）。在平均年龄<50 岁的研究中观察到最佳表现（n=3144704 例，25538 例发生 NOAF，AUC 0.78，95%CI 0.76-0.79）。
CHEST 评分可用于预测初级和二级预防患者以及来自不同国家的患者中的 NOAF。早期发现 NOAF 可能有助于及时开始管理和随访，从而可能降低 AF 相关并发症的发生率。
