Managing Outcomes in Atrial Fibrillation
December 20, 2016
- Use the CHA2DS2-VASc score for determining which patients are at greatest risk of stroke.
- Clinicians should take an individualized approach to antithrombotic therapy.
- Strict rate control is preferred over lenient.
- Catheter ablation is a first-line option.
December 17, 2016
- New multinational study of more than 500 patients found no clear superiority of either strategy.
- The incidence of serious thromboembolic events was low, 2%, and did not differ between the arms.
- More patients in the rate control arm met protocol-specified indications for anticoagulation compared with the rhythm control arm.
December 15, 2016
- Recent guidelines from the American college of Cardiology offer important revisions regarding the management of atrial fibrillation.
- Ablation is now a first-line therapy.
- Cardiologists should now use the more precise risk stratification scoring system.
- Tight heart rate control is preferred over lenient control.
- Antithrombotic therapy is to be individualized based on shared decision-making between patient and physician.
December 10, 2016
- The CHA2DS2-VASc is better at discriminating truly low-risk patients and finding those at high risk as well.
- In the first validation study from the EuroHeart survey, CHA2DS2-VASc had a similar C statistic to CHADS2 but improved prediction in truly low-risk patients and classified only a small proportion into the intermediate-risk category.
- the more precise the risk tool is to assess future risk of stroke, the better the chance that low-risk patients can avoid anticoagulation and that those who will benefit from anticoagulation will be identified accurately.
- The major weakness of CHADS2 is that a substantial proportion of patients (approximately 60%) are assigned a score of 1, indicating an intermediate risk of stroke, and the benefit of application of anticoagulation to this subset is uncertain.