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This website is intended to provide information to an international audience outside the USA and UK
This section covers the epidemiology and demographics of AF, and stroke risk assessment
An uncommon right atrial appendage thrombus
Several risk assessment scoring systems are available to help clinicians estimate the risk of stroke in patients with AF, and guide recommendations for antithrombotic therapy.
|C||Congestive heart failure||1|
|A||Age ≥75 years||1|
Adapted from Gage et al 2001.13
CHADS2 risk assessment does not incorporate a number of documented risk factors for stroke. Patients with a CHADS2 score of 0 are not necessarily at low risk of stroke, and registry data show that anticoagulation decisions simply based on a CHADS2 score of ≥1 may leave many patients at an unacceptable risk of stroke.14
|C||Congestive heart failure/left ventricular dysfunction||1|
|A2||Age ≥75 years||2|
|V||Vascular disease (prior myocardial infarction, peripheral artery disease, aortic plaque)||1|
|A||Age 65−74 years||1|
|Sc||Sex category (i.e. female gender)||1|
Adapted from Lip et al. 2010.17
AF management strategies should aim to avoid stroke, manage symptoms and manage cardiovascular risk factors and co-morbidities. It is important to note that approaches intended to restore normal sinus rhythm do not necessarily reduce the risk of stroke in patients with AF. Therefore, even for patients who have undergone successful cardioversion, long-term anticoagulation may be appropriate when the risk of stroke is high.8
Guidelines recommend the use of antithrombotic therapy for stroke prevention in patients with AF based on an individual’s predicted risk of stroke.8,16
|Risk category||CHA2DS2-VASc score||ESC 20208||AHA/ACC/HRS 201916|
|Anticoagulation recommended. NOAC preferred over VKA||Anticoagulation recommended. NOAC preferred over VKA|
|Anticoagulation treatment should be considered. NOAC preferred over VKA||Treatment with an anticoagulant may be considered. NOAC preferred over VKA.|
|No antithrombotic therapy||No antithrombotic therapy|
ACC, American College of Cardiology; AHA, American Heart Association; ESC, European Society of Cardiology; HRS, Heart Rhythm Society