Background The C 2 HEST score (coronary artery disease or chronic obstructive pulmonary disease [1 point each]; hypertension [1 point]; elderly [age ≥75 years, 2 points]; systolic heart failure [2 points]; thyroid disease [hyperthyroidism, 1 point]) was initially proposed for predicting incident atrial fibrillation (AF) in the general population. Its performance in poststroke patients remains to be established, especially because patients at high risk for incident AF should be targeted for more comprehensive screening. This study aimed to evaluate this newly established incident AF prediction risk score in a post–ischemic stroke population. Methods and Results Validation was based on a hospital‐based nationwide cohort with 240 459 French post–ischemic stroke patients. Kaplan–Meier curves for incident rate of AF depict differences between varying risk categories. Discrimination of the C 2 HEST score was evaluated using the C index, the net reclassification index, integrated discriminatory improvement, and decision curve analysis. During 7.9±11.5 months of follow‐up, 14 095 patients developed incident AF. The incidence of AF increased from 23.5 per 1000 patient‐years in patients with a C 2 HEST score of 0 to 196.8 per 1000 patient‐years in patients with a C 2 HEST score ≥6. Kaplan–Meier curves showed a clear difference among different risk strata (log‐rank P <0.0001). The C 2 HEST score had good discrimination with a C index of 0.734 (95% CI, 0.732–0.736), which was better than the Framingham risk score and the CHA 2 DS 2 ‐VASc score (congestive heart failure, hypertension, age ≥75 [doubled], diabetes mellitus, stroke [doubled], vascular disease, age 65 to 74 years, and female sex) ( P <0.0001, respectively). The C 2 HEST score was also superior to the Framingham risk score and the CHA 2 DS 2 ‐VASc score as shown by the net reclassification index, integrated discriminatory improvement ( P <0.0001, respectively) and decision curve analysis. Conclusions The C 2 HEST score performed well in discriminating the individual risk of developing incident AF in a white European population hospitalized with previous ischemic stroke. This simple score may potentially be used as a risk stratification tool for decision making in relation to a screening strategy for AF in post–ischemic stroke patients.

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SUMMARYVertebrate blood is essential for the growth and the reproduction of haematophagous insects. Provided that hosts play the double role of food sources and predators, feeding on their blood exposes these insects to a high predation risk. Therefore, it is expected that host seeking occurs only when insects need to feed. In the present study, we analyse how the feeding status affects the response to host-associated cues in the blood-sucking insect Rhodnius prolixus. We show that the responsiveness to hostassociated cues, such as CO 2 and heat, and that the motivation to feed depend on the time elapsed since a blood meal. Depending on the time elapsed after feeding, the same concentration of CO 2 may attract or repel the insects. As far as we know, this is the first time that a host signal has been shown to be repellent for a haematophagous insect. The response to heat is also modulated but no repellence was observed. When blood was replaced by saline solution as food, a significant reduction of the response to both signals was evinced but repellence was not observed. The injection of haemolymph from fed insects into starved insects inhibited the response of the receiver insects to both signals but this was not observed after the injection of saline solution or of haemolymph from non-fed insects. This is the first time that the modulation of feeding behaviour by the feeding status has been analysed in a hemimetabolous blood-sucking insect, fully excluding any effect of other processes, such as reproduction.

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Background The incidence of conduction abnormalities requiring permanent pacemaker implantation ( PPI ) after transcatheter aortic valve replacement ( TAVR ) with early and later generation prostheses remains debated. Methods and Results Based on the administrative hospital‐discharge database, we collected information for all patients treated with TAVR between 2010 and 2019 in France. We compared the incidence of PPI after TAVR according to the type and generation of valve implanted. A total of 49 201 patients with aortic stenosis treated with TAVR using the balloon‐expandable ( BE ) Edwards SAPIEN valve (early Sapien XT and latest Sapien 3) or the self‐expanding ( SE ) Medtronic CoreValve (early CoreValve and latest Evolut R) were found in the database. Mean ( SD ) follow‐up was 1.2 (1.5 years) (median [interquartile range] 0.6 [0.1–2.0] years). PPI after the procedure was reported in 13 289 patients, among whom 11 010 (22.4%) had implantation during the first 30 days. In multivariable analysis, using early BE TAVR as reference, adjusted odds ratio (95% CI ) for PPI during the first 30 days was 0.88 (0.81–0.95) for latest BE TAVR , 1.40 (1.27–1.55) for early SE TAVR , and 1.17 (1.07–1.27) for latest SE TAVR . Compared with early BE TAVR , the adjusted hazard ratio for PPI during the whole follow‐up was 1.01 (0.95–1.08) for latest BE TAVR , 1.30 (1.21–1.40) for early SE TAVR , and 1.25 (1.18–1.34) for latest SE TAVR . Conclusions In patients with aortic stenosis treated with TAVR , our systematic analysis at a nationwide level found higher rates of PPI than previously reported. BE technology was independently associated with lower incidence rates of PPI both at the acute and chronic phases than SE technology. Recent generations of TAVR were not independently associated with different rates of PPI than early generations during the overall follow‐up.

Aim: To evaluate the associations between metabolically healthy obesity (MHO) and different types of incident cardiovascular events in a contemporary population.Materials and Methods: All patients discharged from French hospitals in 2013 with at least 5 years of follow-up and without a history of major adverse cardiovascular event (MACE; myocardial infarction, heart failure [HF], ischaemic stroke or cardiovascular death [MACE-HF]) or underweight/malnutrition were identified. They were categorized by phenotypes defined by obesity and three metabolic abnormalities (diabetes, hypertension and hyperlipidaemia). Hazard ratios (HRs) for cardiovascular events during follow-up were adjusted on age, sex and smoking status at baseline. Results: In total, 2 873 039 individuals were included in the analysis, among whom 272 838 (9.5%) had obesity. During a mean follow-up of 4.9 years, when pooling men and women, individuals with MHO had a higher risk of MACE-HF (multivariate-

Background: We hypothesized that the change in stroke risk profile between baseline and follow-up may be a better predictor of ischemic stroke than the baseline stroke risk determination using the CHA2DS2-VASc score ((congestive heart failure, hypertension, age ≥75 years (doubled), diabetes, stroke/transient ischemic attack/thromboembolism (doubled), vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque), age 65–75 years, sex category (female))). Methods: We collected information for all patients treated with atrial fibrillation (AF) in French hospitals between 2010 and 2019. We studied 608,108 patients with AF who did not have risk factors of the CHA2DS2-VASc score (except for age and sex). The predictive accuracies of baseline and follow-up CHA2DS2-VASc scores, as well as the ‘Delta CHA2DS2-VASc’ (i.e., change/difference between the baseline and follow-up CHA2DS2-VASc scores) for prediction of ischemic stroke were studied. Results: The mean CHA2DS2-VASc score at baseline was 1.7, and increased to 2.4 during follow-up of 2.2 ± 2.4 years, (median (interquartile range: IQR) 1.2 (0.1–3.8) years), resulting in a mean Delta CHA2DS2-VASc score of 0.7. Among 20,082 patients suffering ischemic stroke during follow-up, 67.1% had a Delta CHA2DS2-VASc score ≥1 while they were only 40.4% in patients without ischemic stroke. The follow-up CHA2DS2-VASc score and Delta CHA2DS2-VASc score were predictors of ischemic stroke (C-index 0.670, 95% confidence interval (CI) 0.666–0.673 and 0.637, 95%CI 0.633–0.640) and they performed better than baseline CHA2DS2-VASc score (C-index 0.612, 95%CI 0.608–0.615, p < 0.0001). Conclusions: Stroke risk was non-static, and many AF patients had ≥1 new stroke risk factor(s) before ischemic stroke occurred. The follow-up CHA2DS2-VASc score and its change (i.e., ‘Delta CHA2DS2-VASc’) were better predictors of ischemic stroke than relying on the baseline CHA2DS2-VASc score.

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