Abstract
Risk assessments are an important element in the management of patients with atrial fibrillation (AF). In this review, we aim to discuss the concepts and controversies surrounding the various risk factors for stroke and bleeding in AF. Indeed, there are a variety of clinical, electrical, biological, and genetic markers to guide stroke and bleeding risk assessments in AF. The more common factors have been used to formulate risk stratification scores. Some risk factors have shown promise, but others remain less well-defined. Our aim is to discuss concepts and controversies surrounding current evidence of risk factors for stroke and bleeding assessments in AF.
Highlights
Risk assessments are an important element in clinical practice
Higher atrial fibrillation (AF) burden was associated with greater risk of ischemic stroke, transient ischemic attack (TIA), or SE Higher AF burden was associated with greater risk of ischemic stroke or SE Paroxysmal AF was associated with lower risk of stroke or SE compared to persistent and permanent AF Higher AF burden was associated with greater risk of ischemic stroke Presence of atrial high-rate episodes” (AHRE) were associated with a 5.6-fold greater risk of ischemic stroke or SE
A meta-analysis of 18 studies involving 538,479 patients with AF demonstrated that estimated glomerular filtration rate was an independent risk factor for stroke or systemic embolism, with worsening chronic kidney disease (CKD) being associated with a greater increased risk [88]
Summary
Risk assessments are an important element in clinical practice. it is crucial to understand the evidence supporting the individual risk factors to help guide management of patients with complex conditions such as atrial fibrillation (AF). Atrial fibrillation is a multi-systemic disorder that often occurs alongside other comorbidities Many of these co-morbidities are risk factors for incident AF and may increase the risk of subsequent complications. Pooled analysis from five randomized controlled trials (RCTs) demonstrated that a history of stroke or transient ischemic attack (TIA), increasing age, hypertension, diabetes mellitus, and congestive heart failure were individual risk factors for stroke in AF [26]. A more recent systematic review of seven studies which included over 12,000 patients found similar results, there was inconclusive evidence to support congestive heart failure and coronary artery disease as risk factors [28]. TIA or TE Vascular disease+ Increasing age Congestive heart failure Hypertension Diabetes mellitus Female sex*. The impact of AF type (paroxysmal or sustained) on stroke risk remains controversial with earlier studies reporting a similar risk of stroke and systemic
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