Key result
Dynamic risk assessment for stroke and bleeding in atrial fibrillation is recommended over static baseline scoring to account for acquired comorbidities as patients age.
Why the study?
Most stroke and bleeding risk scores in AF are static calculations based on baseline characteristics, despite risk being dynamic as patients age and acquire comorbidities.
Should stroke and bleeding risk in patients with atrial fibrillation be assessed using static or dynamic risk scores?
Should stroke and bleeding risk in patients with atrial fibrillation be assessed using static or dynamic risk scores?
Emphasizes the necessity of regular reassessment of stroke and bleeding risk factors in atrial fibrillation patients, as risk is dynamic and increases with age and acquired comorbidities.
Answers are grounded in this paper and cite their sources.
Dynamic risk assessment merits evaluation in AF; extends static models by capturing acquired risks but leaves open outcome impact.
Atrial fibrillation (AF) is the most prevalent cardiac arrhythmia and a major risk factor for stroke. The number of patients with AF is predicted to increase in the next few decades. AF has also negative impact on quality of life as well as it significantly increases the risk of cardiovascular disease and overall mortality. Because the stroke is a pivotal outcome of AF, its prevention with the use of anticoagulation therapy constitutes an important component of AF management. The decision on oral anticoagulants' prescription should be based on appropriate risk stratification to allow for comprehensive assessment of benefit/hazard ratio of stroke and bleeding along with patients' preference. Several risk scores for stroke and bleeding as well as for stroke and systemic embolism have been developed, mainly in patients on vitamin K antagonists. AF guidelines stress the need for repetitive evaluation of thromboembolic and bleeding risks to tailor optimal AF management. Indeed, risk is not a static "one off" process and it should be adjusted for dynamic nature of risk factors. However, most risk scores are calculated according to baseline characteristics of patients, but the older the patients get, the more comorbidities they acquire, which influences stroke risk significantly. Hence, the default management of every patient with AF should include a regular reassessment of stroke and bleeding risk factors.
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Domek et al. (2019) conducted a review in Atrial fibrillation. Dynamic risk assessment vs. Static risk scores was evaluated. Dynamic risk assessment for stroke and bleeding in atrial fibrillation is recommended over static baseline scoring to account for acquired comorbidities as patients age.
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