{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T01:34:12Z","timestamp":1792805652769,"version":"4.5.0"},"reference-count":19,"publisher":"MDPI AG","issue":"5","license":[{"start":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T00:00:00Z","timestamp":1589500800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001809","name":"National Natural Science Foundation of China","doi-asserted-by":"publisher","award":["H2501"],"award-info":[{"award-number":["H2501"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Health and Family Planning Commission of Heilongjiang Province, China","award":["2017-036"],"award-info":[{"award-number":["2017-036"]}],"id":[{"id":"https:\/\/ror.org\/016dwd637","id-type":"ROR","asserted-by":"crossref"}]},{"name":"NIHR Global Health Research Group on Atrial Fibrillation management at the University of Birmingham, UK","award":["21200"],"award-info":[{"award-number":["21200"]}],"id":[{"id":"https:\/\/ror.org\/03angcq70","id-type":"ROR","asserted-by":"crossref"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>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 \u226575, 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 \u00b1 standard deviation, SD 34 \u00b1 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\u201346), 6 (1\u201349), and 4 (1\u201324) 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 &lt; 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 &lt; 0.001). Conclusions: The C2HEST score, especially when combined with symptoms, could facilitate a targeted population-based screening and preventive strategy for AF.<\/jats:p>","DOI":"10.3390\/jcm9051493","type":"journal-article","created":{"date-parts":[[2020,5,15]],"date-time":"2020-05-15T10:53:59Z","timestamp":1589540039000},"page":"1493","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":33,"title":["Population-Based Screening or Targeted Screening Based on Initial Clinical Risk Assessment for Atrial Fibrillation: A Report from the Huawei Heart Study"],"prefix":"10.3390","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7626-7751","authenticated-orcid":false,"given":"Yutao","family":"Guo","sequence":"first","affiliation":[{"name":"Department of Cardiology, Chinese PLA General Hospital, No.28, Fuxin Road, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hao","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chinese PLA General Hospital, No.28, Fuxin Road, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1942-2513","authenticated-orcid":false,"given":"Hui","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chinese PLA General Hospital, No.28, Fuxin Road, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yundai","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Chinese PLA General Hospital, No.28, Fuxin Road, Beijing 100853, China"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7566-1626","authenticated-orcid":false,"given":"Gregory Y. H.","family":"Lip","sequence":"additional","affiliation":[{"name":"Liverpool Centre for Cardiovascular Sciences, University of Liverpool, Liverpool, Merseyside L7 8TX, UK"},{"name":"Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, DK-9000 Aalborg, Denmark"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2020,5,15]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1851","DOI":"10.1161\/CIRCULATIONAHA.116.026693","article-title":"Screening for Atrial Fibrillation","volume":"135","author":"Freedman","year":"2017","journal-title":"Circulation"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"146","DOI":"10.1001\/jama.2018.8102","article-title":"Effect of a Home-Based Wearable Continuous ECG Monitoring Patch on Detection of Undiagnosed Atrial Fibrillation: The mSToPS Randomized Clinical Trial","volume":"320","author":"Steinhubl","year":"2018","journal-title":"JAMA"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1784","DOI":"10.1161\/CIRCULATIONAHA.117.030583","article-title":"Assessment of Remote Heart Rhythm Sampling Using the AliveCor Heart Monitor to Screen for Atrial Fibrillation","volume":"136","author":"Halcox","year":"2017","journal-title":"Circulation"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1909","DOI":"10.1056\/NEJMoa1901183","article-title":"Large-Scale Assessment of a Smartwatch to Identify Atrial Fibrillation","volume":"381","author":"Perez","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"2365","DOI":"10.1016\/j.jacc.2019.08.019","article-title":"Mobile Photoplethysmographic Technology to Detect Atrial Fibrillation","volume":"74","author":"Guo","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1016\/j.ijcard.2018.02.051","article-title":"Risk factors for new-onset atrial fibrillation: A focus on Asian populations","volume":"261","author":"Li","year":"2018","journal-title":"Int. J. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"739","DOI":"10.1016\/S0140-6736(09)60443-8","article-title":"Development of a risk score for atrial fibrillation (Framingham Heart Study): A community-based cohort study","volume":"373","author":"Schnabel","year":"2009","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.amjcard.2010.08.049","article-title":"A Clinical Risk Score for Atrial Fibrillation in a Biracial Prospective Cohort (from the Atherosclerosis Risk In Communities [ARIC] Study)","volume":"107","author":"Chamberlain","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"e000102","DOI":"10.1161\/JAHA.112.000102","article-title":"Simple Risk Model Predicts Incidence of Atrial Fibrillation in a Racially and Geographically Diverse Population: The CHARGE-AF Consortium","volume":"2","author":"Alonso","year":"2013","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1016\/j.chest.2018.09.011","article-title":"A Simple Clinical Risk Score (C2HEST) for Predicting Incident Atrial Fibrillation in Asian Subjects: Derivation in 471,446 Chinese Subjects, With Internal Validation and External Application in 451,199 Korean Subjects","volume":"155","author":"Li","year":"2018","journal-title":"Chest"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e012546","DOI":"10.1161\/JAHA.119.012546","article-title":"C2 HEST Score and Prediction of Incident Atrial Fibrillation in Poststroke Patients: A French Nationwide Study","volume":"8","author":"Li","year":"2019","journal-title":"J. Am. Hear. Assoc."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1016\/j.amjcard.2019.09.034","article-title":"Evaluation of the C2HEST Risk Score as a Possible Opportunistic Screening Tool for Incident Atrial Fibrillation in a Healthy Population (From a Nationwide Danish Cohort Study)","volume":"125","author":"Lip","year":"2019","journal-title":"Am. J. Cardiol."},{"key":"ref_13","first-page":"e13352","article-title":"Mobile Health (mHealth) technology for improved screening, patient involvement and optimising integrated care in atrial fibrillation: The mAFA (mAF-App) II randomised trial","volume":"73","author":"Guo","year":"2019","journal-title":"Int. J. Clin. Pr."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"e11437","DOI":"10.2196\/11437","article-title":"Diagnostic Performance of a Smart Device With Photoplethysmography Technology for Atrial Fibrillation Detection: Pilot Study (Pre-mAFA II Registry)","volume":"7","author":"Fan","year":"2019","journal-title":"JMIR mHealth uHealth"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2176","DOI":"10.1161\/CIRCULATIONAHA.114.014343","article-title":"Mass Screening for Untreated Atrial Fibrillation","volume":"131","author":"Svennberg","year":"2015","journal-title":"Circ."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"1504","DOI":"10.1093\/eurheartj\/ehy837","article-title":"Age threshold for the use of non-vitamin K antagonist oral anticoagulants for stroke prevention in patients with atrial fibrillation: Insights into the optimal assessment of age and incident comorbidities","volume":"40","author":"Chao","year":"2019","journal-title":"Eur. Hear. J."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1378\/chest.14-0321","article-title":"Prevalence, Incidence, and Lifetime Risk of Atrial Fibrillation in China","volume":"147","author":"Guo","year":"2015","journal-title":"Chest"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"1580","DOI":"10.1253\/circj.CJ-17-0277","article-title":"Development of a Basic Risk Score for Incident Atrial Fibrillation in a Japanese General Population\u2015The Suita Study","volume":"81","author":"Kokubo","year":"2017","journal-title":"Circ. J."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"515","DOI":"10.4070\/kcj.2016.46.4.515","article-title":"Incidence and Risk Factors for Atrial Fibrillation in Korea: The National Health Insurance Service Database (2002\u20132010)","volume":"46","author":"Son","year":"2016","journal-title":"Korean Circ. J."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1493\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T09:29:14Z","timestamp":1760174954000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/9\/5\/1493"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,5,15]]},"references-count":19,"journal-issue":{"issue":"5","published-online":{"date-parts":[[2020,5]]}},"alternative-id":["jcm9051493"],"URL":"https:\/\/doi.org\/10.3390\/jcm9051493","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,5,15]]}}}