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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.
|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. 2010.15
AF management strategies should aim to relieve symptoms (when present), optimize cardiac function, and minimize the risk of stroke. 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, lifelong anticoagulation may be appropriate when the risk of stroke or recurrent AF is high.3
|Risk category||CHADS2 score||CHA2DS2-VASc score||ESC 20163||AHA/ACC/HRS 20149|
|Moderate||1||1d||NOAC should be considered based upon an assessment of individual characteristics and patient preferencesdd,e||No antithrombotic therapy or treatment with a NOAC or ASA may be considered|
|Low||0||0||No antithrombotic therapy||No antithrombotic therapy|
aOne ‘major’ risk factor or ≥2 ‘clinically relevant non-major’ risk factors; bCHA2DS2-VASc score of ≥2 in males and ≥3 in females is considered high risk according to ESC guidelines; cNOACs are recommended in preference to VKA therapy; done ‘clinically relevant non-major’ risk factor; efemale patients who are aged <65 years and have lone AF (but still have a CHA2DS2-VASc score of 1 by virtue of their gender) are low risk and no antithrombotic therapy should be considered
ACC, American College of Cardiology; AHA, American Heart Association; ESC, European Society of Cardiology; HRS, Heart Rhythm Society