Key result
A novel risk stratification approach for atrial fibrillation proposes shifting focus from the risk of stroke and major bleeding to the mortality associated with these events.
Why the study?
Current AF risk stratification focuses on morbidity rather than mortality, leading to therapeutic inertia and underdosing because physicians may weigh stroke and major bleeding risks equally.
Does a risk stratification approach based on mortality associated with stroke and bleeding improve management in patients with atrial fibrillation compared to traditional event-based stratification?
Does a risk stratification approach based on mortality associated with stroke and bleeding improve management in patients with atrial fibrillation compared to traditional event-based stratification?
Shifting risk stratification in atrial fibrillation from morbidity to mortality may help overcome therapeutic inertia and inappropriate underdosing of anticoagulants.
Atrial fibrillation is associated with a five-fold increase in the risk of stroke. Current guidelines recommend the use of the CHA2DS2-VASc score to stratify the risk of stroke. In addition, guidelines recommend the identification of the conditions that increase the risk of haemorrhage to be modified and thus decrease the risk of bleeding. Nevertheless, many patients with a high thromboembolic risk are prescribed antiplatelet treatment or do not receive any antithrombotic therapy. In addition, therapeutic inertia is common in anticoagulated patients taking vitamin K antagonists, and underdosing is an emerging problem with direct oral anticoagulants, probably because many physicians consider the risk of stroke and the risk of major bleeding to be equal. It is necessary to develop a new approach to risk stratification, an approach that moves from morbidity to mortality, i.e., from stratification of the risk of stroke and major bleeding to stratification of the risk of mortality associated with stroke and the risk of mortality associated with bleeding. In this article, we propose a novel risk stratification approach based on the mortality associated with stroke and bleeding, illustrated by data derived from the literature.
No takes yet. Share an insight, caveat, or question.
Escobar et al. (2020) conducted a review in Atrial fibrillation. Novel risk stratification approach was evaluated. A novel risk stratification approach for atrial fibrillation proposes shifting focus from the risk of stroke and major bleeding to the mortality associated with these events.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: