Abstract
Atrial fibrillation (AF) is the most common arrhythmia in the adult general population. As populations age, the global burden of AF is expected to rise. AF is associated with stroke and thromboembolic complications, which contribute to significant morbidity and mortality. As a result, it remains paramount to identify patients at elevated risk of thromboembolism and to determine who will benefit from thromboembolic prophylaxis. Conventional practice advocates the use of clinical risk scoring criteria to identify patients at risk of thromboembolic complications. These risk scores have modest discriminatory ability in many sub-populations of patients with AF, highlighting the need for improved risk stratification tools. New insights have been gained on the utility of biomarkers and imaging modalities, and there is emerging data on the importance of the identification and treatment of subclinical AF. Finally, the advent of wearable devices to detect cardiac arrhythmias pose a new and evolving challenge in the practice of cardiology. This review aims to address strategies to enhance thromboembolic risk stratification and identify challenges with current and future practice.
Highlights
Atrial fibrillation (AF) is the most common clinically significant arrhythmia in the adult general population [1]
This has a substantial implication to public health, as AF is associated with heart failure and thromboembolic complications, both of which lead to morbidity and mortality [3]
This suggests that the temporal relationship between atrial arrhythmia and stroke is not fully understood, and the complication of thromboembolism may not be solely due to the presence of AF
Summary
Atrial fibrillation (AF) is the most common clinically significant arrhythmia in the adult general population [1]. Population-based studies have estimated that AF will affect over 5.6 million patients in the United States alone by the year 2050 [2]. This has a substantial implication to public health, as AF is associated with heart failure and thromboembolic complications, both of which lead to morbidity and mortality [3]. The discriminatory ability of clinical risk scores to predict stroke risk in any given individual is moderate at best. Several studies assessing the utility of various clinical risk scores have shown moderate performance in stroke prediction with C-statistics of 0.65–0.70 [7]
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