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Comparing atrial fibrillation guidelines: Focus on stroke prevention, bleeding risk assessment and oral anticoagulant recommendations

  • Jacopo Francesco Imberti
    Affiliations
    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy

    Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy

    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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  • Davide Antonio Mei
    Affiliations
    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy
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  • Marco Vitolo
    Affiliations
    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy

    Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy

    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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  • Niccolò Bonini
    Affiliations
    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy

    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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  • Marco Proietti
    Affiliations
    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK

    Department of Clinical Sciences and Community Health, University of Milan, Milan, Italy

    Geriatric Unit, IRCCS Istituti Clinici Scientifici Maugeri, Milan, Italy
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  • Tatjana Potpara
    Affiliations
    School of Medicine, Belgrade University, dr Subotica 8, Belgrade 11000, Serbia

    Cardiology Clinic, Clinical Centre of Serbia, Visegradska 26, Belgrade 11000, Serbia
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  • Gregory Y.H. Lip
    Affiliations
    Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, UK
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  • Giuseppe Boriani
    Correspondence
    Corresponding author.
    Affiliations
    Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, Policlinico di Modena, University of Modena and Reggio Emilia, Via del Pozzo, 71, Modena 41124, Italy
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      Highlights

      • The clinical complexity of atrial fibrillation (AF) patients is increasing with population aging and multimorbidity is associated with higher risk of adverse outcomes.
      • In the past 3 years, four new AF international guidelines or focused updates have been published, highlighting the centrality of this evolving field.
      • Thromboembolic and bleeding risks evaluation at baseline and reassessment during follow-up was evenly recommended.
      • Oral anticoagulants prescription was consistently recommended.
      • Latest guidelines emphasize the importance of a holistic and integrated approach to patient care.

      Abstract

      Clinical practice in atrial fibrillation (AF) patient management is constantly evolving. In the past 3 years, various new AF guidelines or focused updates have been published, given this rapidly evolving field. In 2019, the American College of Cardiology/American Heart Association published a focused update of the 2014 guidelines. In 2020, both the European Society of Cardiology and the Canadian Cardiovascular Society released their new guidelines. Finally, the most recent guidelines were those published in 2021 by the Asian Pacific Heart Rhythm Society, which updates their 2017 version and the 2021 National Institute for Health and Care Excellence (NICE) guidelines. In the present narrative review, we compare these guidelines, emphasizing similarities and differences in the following mainstay elements of patient care: thromboembolic risk assessment, oral anticoagulants (OACs) prescription, bleeding risk evaluation, and integrated patient management. A formal evaluation of baseline thromboembolic and bleeding risks and their reassessment during follow-up is evenly recommended, although some differences in using risk stratification scores. OACs prescription is highly encouraged where appropriate, and prescription algorithms are broadly similar. The importance of an integrated and multidisciplinary approach to patient care is emerging, aiming to address several different aspects of a multifaceted disease.

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      References

        • Ruff C.T.
        • Giugliano R.P.
        • Braunwald E.
        • Hoffman E.B.
        • Deenadayalu N.
        • Ezekowitz M.D.
        • et al.
        Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.
        Lancet. 2014; 383: 955-962
        • January C.T.
        • Wann L.S.
        • Calkins H.
        • Chen L.Y.
        • Cigarroa J.E.
        • Cleveland J.C.
        • et al.
        2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on clinical practice guidelines and the heart rhythm society in collaboration with the society of thoracic surgeons.
        Circulation. 2019; 140: e125-ee51
        • Andrade J.G.
        • Aguilar M.
        • Atzema C.
        • Bell A.
        • Cairns J.A.
        • Cheung C.C.
        • et al.
        The 2020 Canadian cardiovascular society/Canadian heart rhythm society comprehensive guidelines for the management of atrial fibrillation.
        Can J Cardiol. 2020; 36: 1847-1948
        • Hindricks G.
        • Potpara T.
        • Dagres N.
        • Arbelo E.
        • Bax J.J.
        • Blomström-Lundqvist C.
        • et al.
        2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS).
        Eur Heart J. 2020; 42(5): 373-498
        • Chao T.F.
        • Joung B.
        • Takahashi Y.
        • Lim T.W.
        • Choi E.K.
        • Chan Y.H.
        • et al.
        2021 focused update consensus guidelines of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation: executive summary.
        Thromb Haemost. 2021; 122(1): 20-47
      1. Atrial fibrillation: diagnosis and management. NICE guideline [NG196]. 2021. https://www.nice.org.uk/guidance/ng196.

        • Guo Y.
        • Kotalczyk A.
        • Imberti J.F.
        • Wang Y.
        • Lip G.Y.
        • Investigators C.R.
        Oral anticoagulation improves survival in very elderly Chinese patients with atrial fibrillation: a report from the optimal thromboprophylaxis in elderly Chinese patients with atrial fibrillation (ChiOTEAF) registry.
        Int J Stroke. 2021; Epub ahead of print (17474930211046743)https://doi.org/10.1177/17474930211046743
        • van Walraven C.
        • Hart R.G.
        • Singer D.E.
        • Laupacis A.
        • Connolly S.
        • Petersen P.
        • et al.
        Oral anticoagulants vs aspirin in nonvalvular atrial fibrillation: an individual patient meta-analysis.
        JAMA. 2002; 288: 2441-2448
        • Guo Y.
        • Kotalczyk A.
        • Imberti J.F.
        • Wang Y.
        • Lip G.Y.H.
        Investigators CR. Poor adherence to guideline-directed anticoagulation in elderly Chinese patients with atrial fibrillation. A report from the optimal thromboprophylaxis in elderly Chinese patients with atrial fibrillation (ChiOTEAF) registry.
        Eur Heart J Qual Care Clin Outcomes. 2021; Epub ahead of printhttps://doi.org/10.1093/ehjqcco/qcab054
        • Boriani G.
        • Imberti J.F.
        • Vitolo M.
        Anticoagulation to prevent ischaemic stroke in patients with atrial fibrillation: a complex scenario including underdiagnosis, undertreatment, or underdosing of oral anticoagulants.
        Eur Heart J Qual Care Clin Outcomes. 2020; 6: 95-97
        • Vitolo M.
        • Proietti M.
        • Shantsila A.
        • Boriani G.
        • Lip G.Y.H.
        Clinical phenotype classification of atrial fibrillation patients using cluster analysis and associations with trial-adjudicated outcomes.
        Biomedicines. 2021; 9: 843
        • Proietti M.
        • Vitolo M.
        • Harrison S.L.
        • Lane D.A.
        • Fauchier L.
        • Marin F.
        • et al.
        Impact of clinical phenotypes on management and outcomes in European atrial fibrillation patients: a report from the ESC-EHRA EURobservational research programme in AF (EORP-AF) general long-term registry.
        BMC Med. 2021; 19: 256
        • Burdett P.
        • Lip G.Y.H.
        Atrial fibrillation in the United Kingdom: predicting costs of an emerging epidemic recognising and forecasting the cost drivers of atrial fibrillation-related costs.
        Eur Heart J Qual Care Clin Outcomes. 2020; 8(2): 187-194
        • Kirchhof P.
        The future of atrial fibrillation management: integrated care and stratified therapy.
        Lancet. 2017; 390: 1873-1887
        • Kotecha D.
        • Breithardt G.
        • Camm A.J.
        • Lip G.Y.H.
        • Schotten U.
        • Ahlsson A.
        • et al.
        Integrating new approaches to atrial fibrillation management: the 6th AFNET/EHRA consensus conference.
        Europace. 2018; 20: 395-407
        • Proietti M.
        • Lane D.A.
        • Boriani G.
        • Lip G.Y.H.
        Stroke Prevention, evaluation of bleeding risk, and anticoagulant treatment management in atrial fibrillation contemporary international guidelines.
        Can J Cardiol. 2019; 35: 619-633
        • January C.T.
        • Wann L.S.
        • Alpert J.S.
        • Calkins H.
        • Cigarroa J.E.
        • Cleveland J.C.
        • et al.
        2014 AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American college of cardiology/American heart association task force on practice guidelines and the heart rhythm society.
        Circulation. 2014; 130: e199-e267
        • Chiang C.E.
        • Okumura K.
        • Zhang S.
        • Chao T.F.
        • Siu C.W.
        • Wei Lim T.
        • et al.
        2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.
        J Arrhythm. 2017; 33: 345-367
        • Wolf P.A.
        • Abbott R.D.
        • Kannel W.B.
        Atrial fibrillation as an independent risk factor for stroke: the Framingham study.
        Stroke. 1991; 22: 983-988
        • Borre E.D.
        • Goode A.
        • Raitz G.
        • Shah B.
        • Lowenstern A.
        • Chatterjee R.
        • et al.
        Predicting thromboembolic and bleeding event risk in patients with non-valvular atrial fibrillation: a systematic review.
        Thromb Haemost. 2018; 118: 2171-2187
        • Oldgren J.
        • Hijazi Z.
        • Lindbäck J.
        • Alexander J.H.
        • Connolly S.J.
        • Eikelboom J.W.
        • et al.
        Performance and validation of a novel biomarker-based stroke risk score for atrial fibrillation.
        Circulation. 2016; 134: 1697-1707
        • Singer D.E.
        • Chang Y.
        • Borowsky L.H.
        • Fang M.C.
        • Pomernacki N.K.
        • Udaltsova N.
        • et al.
        A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: the ATRIA study stroke risk score.
        J Am Heart Assoc. 2013; 2e000250
        • Hijazi Z.
        • Lindbäck J.
        • Alexander J.H.
        • Hanna M.
        • Held C.
        • Hylek E.M.
        • et al.
        The ABC (age, biomarkers, clinical history) stroke risk score: a biomarker-based risk score for predicting stroke in atrial fibrillation.
        Eur Heart J. 2016; 37: 1582-1590
        • Rivera-Caravaca J.M.
        • Marín F.
        • Vilchez J.A.
        • Gálvez J.
        • Esteve-Pastor M.A.
        • Vicente V.
        • et al.
        Refining stroke and bleeding prediction in atrial fibrillation by adding consecutive biomarkers to clinical risk scores.
        Stroke. 2019; 50: 1372-1379
        • Lip G.Y.
        • Nieuwlaat R.
        • Pisters R.
        • Lane D.A.
        • Crijns H.J.
        Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation.
        Chest. 2010; 137: 263-272
        • Ntaios G.
        • Lip G.Y.
        • Makaritsis K.
        • Papavasileiou V.
        • Vemmou A.
        • Koroboki E.
        • et al.
        CHADS₂, CHA₂S₂DS₂-VASc, and long-term stroke outcome in patients without atrial fibrillation.
        Neurology. 2013; 80: 1009-1017
        • Friberg L.
        • Rosenqvist M.
        • Lip G.Y.
        Evaluation of risk stratification schemes for ischaemic stroke and bleeding in 182 678 patients with atrial fibrillation: the Swedish Atrial Fibrillation cohort study.
        Eur Heart J. 2012; 33: 1500-1510
        • Okumura K.
        • Inoue H.
        • Atarashi H.
        • Yamashita T.
        • Tomita H.
        • Origasa H.
        • et al.
        Validation of CHA₂DS₂-VASc and HAS-BLED scores in Japanese patients with nonvalvular atrial fibrillation: an analysis of the J-RHYTHM registry.
        Circ J. 2014; 78: 1593-1599
        • Jung H.
        • Yang P.S.
        • Sung J.H.
        • Jang E.
        • Yu H.T.
        • Kim T.H.
        • et al.
        Hypertrophic cardiomyopathy in patients with atrial fibrillation: prevalence and associated stroke risks in a nationwide cohort study.
        Thromb Haemost. 2019; 119: 285-293
        • Jung H.
        • Sung J.H.
        • Yang P.S.
        • Jang E.
        • Yu H.T.
        • Kim T.H.
        • et al.
        Stroke risk stratification for atrial fibrillation patients with hypertrophic cardiomyopathy.
        J Am Coll Cardiol. 2018; 72: 2409-2411
        • Kim T.H.
        • Yang P.S.
        • Kim D.
        • Yu H.T.
        • Uhm J.S.
        • Kim J.Y.
        • et al.
        CHA2DS2-VASc score for identifying truly low-risk atrial fibrillation for stroke: a korean nationwide cohort study.
        Stroke. 2017; 48: 2984-2990
        • Proietti M.
        • Farcomeni A.
        • Romiti G.F.
        • Di Rocco A.
        • Placentino F.
        • Diemberger I.
        • et al.
        Association between clinical risk scores and mortality in atrial fibrillation: systematic review and network meta-regression of 669,000 patients.
        Eur J Prev Cardiol. 2020; 27: 633-644
        • Nielsen P.B.
        • Overvad T.F.
        Female sex as a risk modifier for stroke risk in atrial fibrillation: using CHA2DS2-VASc versus CHA2DS2-VA for stroke risk stratification in atrial fibrillation: a note of caution.
        Thromb Haemost. 2020; 120: 894-898
        • Yoon M.
        • Yang P.S.
        • Jang E.
        • Yu H.T.
        • Kim T.H.
        • Uhm J.S.
        • et al.
        Dynamic changes of CHA2DS2-VASc score and the risk of ischaemic stroke in Asian patients with atrial fibrillation: a nationwide cohort study.
        Thromb Haemost. 2018; 118: 1296-1304
        • Chao T.F.
        • Liao J.N.
        • Tuan T.C.
        • Lin Y.J.
        • Chang S.L.
        • Lo L.W.
        • et al.
        Incident co-morbidities in patients with atrial fibrillation initially with a CHA2DS2-VASc score of 0 (males) or 1 (females): implications for reassessment of stroke risk in initially 'low-risk' patients.
        Thromb Haemost. 2019; 119: 1162-1170
        • Chao T.F.
        • Chiang C.E.
        • Chen T.J.
        • Lip G.Y.H.
        • Chen S.A.
        Reassessment of risk for stroke during follow-up of patients with atrial fibrillation.
        Ann Intern Med. 2019; 170: 663-664
        • Volgman A.S.
        • Benjamin E.J.
        • Curtis A.B.
        • Fang M.C.
        • Lindley K.J.
        • Naccarelli G.V.
        • et al.
        Women and atrial fibrillation.
        J Cardiovasc Electrophysiol. 2021; 32: 2793-2807
        • Imberti J.F.
        • Boriani G.
        • Gupta D.
        • Lip G.Y.H.
        Procedural complications in patients undergoing catheter ablation for atrial fibrillation: let's talk about sex.
        Eur Heart J Qual Care Clin Outcomes. 2021; 7: 427-428
        • Boriani G.
        • Colella J.
        • Imberti J.
        • Fantecchi E.
        • Vitolo M.
        Female sex and stroke in atrial fibrillation: an intriguing relationship.
        Intern Emerg Med. 2020; 15: 175-179
        • Camm A.J.
        • Kirchhof P.
        • Lip G.Y.
        • Schotten U.
        • Savelieva I.
        • Ernst S.
        • et al.
        Guidelines for the management of atrial fibrillation: the task force for the management of atrial fibrillation of the European society of cardiology (ESC).
        Eur Heart J. 2010; 31: 2369-2429
        • Gage B.F.
        • Waterman A.D.
        • Shannon W.
        • Boechler M.
        • Rich M.W.
        • Radford M.J.
        Validation of clinical classification schemes for predicting stroke: results from the national registry of atrial fibrillation.
        JAMA. 2001; 285: 2864-2870
        • Camm A.J.
        • Savelieva I.
        Female gender as a risk factor for stroke associated with atrial fibrillation.
        Eur Heart J. 2017; 38: 1480-1484
        • Group SRiAFW
        Independent predictors of stroke in patients with atrial fibrillation: a systematic review.
        Neurology. 2007; 69: 546-554
        • Marzona I.
        • Proietti M.
        • Farcomeni A.
        • Romiti G.F.
        • Romanazzi I.
        • Raparelli V.
        • et al.
        Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation: a systematic review and meta-analysis of 993,600 patients.
        Int J Cardiol. 2018; 269: 182-191
        • Nielsen P.B.
        • Skjøth F.
        • Overvad T.F.
        • Larsen T.B.
        • Lip G.Y.H.
        Female sex is a risk modifier rather than a risk factor for stroke in atrial fibrillation: should we use a CHA2DS2-VA score rather than CHA2DS2-VASc?.
        Circulation. 2018; 137: 832-840
        • Ogilvie I.M.
        • Newton N.
        • Welner S.A.
        • Cowell W.
        • Lip G.Y.
        Underuse of oral anticoagulants in atrial fibrillation: a systematic review.
        Am J Med. 2010; 123 (e4): 638-645
        • Pilcher S.M.
        • Alamneh E.A.
        • Chalmers L.
        • Bereznicki LR.
        The tasmanian atrial fibrillation study (TAFS): differences in stroke prevention according to sex.
        Ann Pharmacother. 2020; 54: 837-845
        • Proietti M.
        • Cheli P.
        • Basili S.
        • Mazurek M.
        • Lip G.Y.
        Balancing thromboembolic and bleeding risk with non-vitamin K antagonist oral anticoagulants (NOACs): a systematic review and meta-analysis on gender differences.
        Pharmacol Res. 2017; 117: 274-282
        • Zielinski G.D.
        • van Rein N.
        • Teichert M.
        • Klok F.A.
        • Rosendaal F.R.
        • van der Meer F.J.M.
        • et al.
        Persistence of oral anticoagulant treatment for atrial fibrillation in the Netherlands: a surveillance study.
        Res Pract Thromb Haemost. 2020; 4: 141-153
        • Hilkens N.A.
        • Algra A.
        • Greving J.P.
        Predicting major bleeding in ischemic stroke patients with atrial fibrillation.
        Stroke. 2017; 48: 3142-3144
        • Proietti M.
        • Hijazi Z.
        • Andersson U.
        • Connolly S.J.
        • Eikelboom J.W.
        • Ezekowitz M.D.
        • et al.
        Comparison of bleeding risk scores in patients with atrial fibrillation: insights from the RE-LY trial.
        J Intern Med. 2018; 283: 282-292
        • Mori N.
        • Sotomi Y.
        • Hirata A.
        • Hirayama A.
        • Sakata Y.
        • Higuchi Y.
        External validation of the ORBIT bleeding score and the HAS-BLED score in nonvalvular atrial fibrillation patients using direct oral anticoagulants (Asian data from the DIRECT registry).
        Am J Cardiol. 2019; 124: 1044-1048
        • Wattanaruengchai P.
        • Nathisuwan S.
        • Karaketklang K.
        • Wongcharoen W.
        • Phrommintikul A.
        • Lip G.Y.H.
        Comparison of the HAS-BLED versus ORBIT scores in predicting major bleeding among Asians receiving direct-acting oral anticoagulants.
        Br J Clin Pharmacol. 2021; 88(5): 2203-2212
        • Proietti M.
        • Romiti G.F.
        • Vitolo M.
        • Potpara T.S.
        • Boriani G.
        • Lip G.Y.H.
        Comparison of HAS-BLED and ORBIT bleeding risk scores in AF patients treated with NOACs: a report from the ESC-EHRA EORP-AF general long-term registry.
        Eur Heart J Qual Care Clin Outcomes. 2021; Epub ahead of printhttps://doi.org/10.1093/ehjqcco/qcab069
        • Esteve-Pastor M.A.
        • García-Fernández A.
        • Macías M.
        • Sogorb F.
        • Valdés M.
        • Roldán V.
        • et al.
        Is the ORBIT bleeding risk score superior to the HAS-BLED score in anticoagulated atrial fibrillation patients?.
        Circ J. 2016; 80: 2102-2108
        • Pisters R.
        • Lane D.A.
        • Nieuwlaat R.
        • de Vos C.B.
        • Crijns H.J.
        • Lip G.Y.
        A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the euro heart survey.
        Chest. 2010; 138: 1093-1100
        • Gao X.
        • Cai X.
        • Yang Y.
        • Zhou Y.
        • Zhu W.
        Diagnostic Accuracy of the HAS-BLED bleeding score in VKA- or DOAC-treated patients with atrial fibrillation: a systematic review and meta-analysis.
        Front Cardiovasc Med. 2021; 8757087
        • Wang C.
        • Yu Y.
        • Zhu W.
        • Yu J.
        • Lip G.Y.H.
        • Hong K.
        Comparing the ORBIT and HAS-BLED bleeding risk scores in anticoagulated atrial fibrillation patients: a systematic review and meta-analysis.
        Oncotarget. 2017; 8: 109703-109711
        • Guo Y.
        • Zhu H.
        • Chen Y.
        • Lip G.Y.H.
        Comparing bleeding risk assessment focused on modifiable risk factors only versus validated bleeding risk scores in atrial fibrillation.
        Am J Med. 2018; 131: 185-192
        • Chao T.F.
        • Lip G.Y.H.
        • Lin Y.J.
        • Chang S.L.
        • Lo L.W.
        • Hu Y.F.
        • et al.
        Incident risk factors and major bleeding in patients with atrial fibrillation treated with oral anticoagulants: a comparison of baseline, follow-up and delta has-bled scores with an approach focused on modifiable bleeding risk factors.
        Thromb Haemost. 2018; 118: 768-777
        • Chao T.F.
        • Lip G.Y.H.
        • Lin Y.J.
        • Chang S.L.
        • Lo L.W.
        • Hu Y.F.
        • et al.
        Major bleeding and intracranial hemorrhage risk prediction in patients with atrial fibrillation: attention to modifiable bleeding risk factors or use of a bleeding risk stratification score? A nationwide cohort study.
        Int J Cardiol. 2018; 254: 157-161
        • Esteve-Pastor M.A.
        • Rivera-Caravaca J.M.
        • Shantsila A.
        • Roldán V.
        • Lip G.Y.H.
        • Marín F.
        Assessing bleeding risk in atrial fibrillation patients: comparing a bleeding risk score based only on modifiable bleeding risk factors against the HAS-BLED Score. The AMADEUS trial.
        Thromb Haemost. 2017; 117: 2261-2266
        • Fox K.A.A.
        • Lucas J.E.
        • Pieper K.S.
        • Bassand J.P.
        • Camm A.J.
        • Fitzmaurice D.A.
        • et al.
        Improved risk stratification of patients with atrial fibrillation: an integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation.
        BMJ Open. 2017; 7e017157
        • Berg D.D.
        • Ruff C.T.
        • Jarolim P.
        • Giugliano R.P.
        • Nordio F.
        • Lanz H.J.
        • et al.
        Performance of the ABC scores for assessing the risk of stroke or systemic embolism and bleeding in patients with atrial fibrillation in ENGAGE AF-TIMI 48.
        Circulation. 2019; 139: 760-771
        • Hijazi Z.
        • Oldgren J.
        • Lindbäck J.
        • Alexander J.H.
        • Connolly S.J.
        • Eikelboom J.W.
        • et al.
        The novel biomarker-based ABC (age, biomarkers, clinical history)-bleeding risk score for patients with atrial fibrillation: a derivation and validation study.
        Lancet. 2016; 387: 2302-2311
        • Gage B.F.
        • Yan Y.
        • Milligan P.E.
        • Waterman A.D.
        • Culverhouse R.
        • Rich M.W.
        • et al.
        Clinical classification schemes for predicting hemorrhage: results from the national registry of atrial fibrillation (NRAF).
        Am Heart J. 2006; 151: 713-719
        • Fang M.C.
        • Go A.S.
        • Chang Y.
        • Borowsky L.H.
        • Pomernacki N.K.
        • Udaltsova N.
        • et al.
        A new risk scheme to predict warfarin-associated hemorrhage: the ATRIA (Anticoagulation and risk factors in atrial fibrillation) study.
        J Am Coll Cardiol. 2011; 58: 395-401
        • O'Brien E.C.
        • Simon D.N.
        • Thomas L.E.
        • Hylek E.M.
        • Gersh B.J.
        • Ansell J.E.
        • et al.
        The ORBIT bleeding score: a simple bedside score to assess bleeding risk in atrial fibrillation.
        Eur Heart J. 2015; 36: 3258-3264
        • Rohla M.
        • Weiss T.W.
        • Pecen L.
        • Patti G.
        • Siller-Matula J.M.
        • Schnabel R.B.
        • et al.
        Risk factors for thromboembolic and bleeding events in anticoagulated patients with atrial fibrillation: the prospective, multicentre observational PREvention oF thromboembolic events - European registry in atrial fibrillation (PREFER in AF).
        BMJ Open. 2019; 9e022478
        • Yao X.
        • Gersh B.J.
        • Sangaralingham L.R.
        • Kent D.M.
        • Shah N.D.
        • Abraham N.S.
        • et al.
        Comparison of the CHA.
        Am J Cardiol. 2017; 120: 1549-1556
        • LaMori J.C.
        • Mody S.H.
        • Gross H.J.
        • daCosta DiBonaventura M.
        • Patel A.A.
        • Schein J.R.
        • et al.
        Burden of comorbidities among patients with atrial fibrillation.
        Ther Adv Cardiovasc Dis. 2013; 7: 53-62
        • Pokorney S.D.
        • Piccini J.P.
        • Stevens S.R.
        • Patel M.R.
        • Pieper K.S.
        • Halperin J.L.
        • et al.
        Cause of death and predictors of all-cause mortality in anticoagulated patients with nonvalvular atrial fibrillation: data from ROCKET AF.
        J Am Heart Assoc. 2016; 5e002197
        • Fauchier L.
        • Lecoq C.
        • Clementy N.
        • Bernard A.
        • Angoulvant D.
        • Ivanes F.
        • et al.
        Oral anticoagulation and the risk of stroke or death in patients with atrial fibrillation and one additional stroke risk factor: the loire valley atrial fibrillation project.
        Chest. 2016; 149: 960-968
        • Gallagher C.
        • Elliott A.D.
        • Wong C.X.
        • Rangnekar G.
        • Middeldorp M.E.
        • Mahajan R.
        • et al.
        Integrated care in atrial fibrillation: a systematic review and meta-analysis.
        Heart. 2017; 103: 1947-1953
        • Romiti G.F.
        • Pastori D.
        • Rivera-Caravaca J.M.
        • Ding W.Y.
        • Gue Y.X.
        • Menichelli D.
        • et al.
        Adherence to the ‘atrial fibrillation Better Care’ (ABC) pathway in patients with atrial fibrillation.
        Thromb Haemost. 2021; 122(3): 406-414
        • Lip G.Y.H.
        The ABC pathway: an integrated approach to improve AF management.
        Nat Rev Cardiol. 2017; 14: 627-628
        • Yoon M.
        • Yang P.S.
        • Jang E.
        • Yu H.T.
        • Kim T.H.
        • Uhm J.S.
        • et al.
        Improved population-based clinical outcomes of patients with atrial fibrillation by compliance with the simple ABC (Atrial fibrillation Better Care) pathway for integrated care management: a nationwide cohort study.
        Thromb Haemost. 2019; 119: 1695-1703
        • Proietti M.
        • Lip G.Y.H.
        • Laroche C.
        • Fauchier L.
        • Marin F.
        • Nabauer M.
        • et al.
        Relation of outcomes to ABC (Atrial fibrillation Better Care) pathway adherent care in European patients with atrial fibrillation: an analysis from the ESC-EHRA EORP atrial fibrillation general long-term (AFGen LT) registry.
        Europace. 2021; 23: 174-183
        • Guo Y.
        • Imberti J.F.
        • Kotalczyk A.
        • Wang Y.
        • Lip G.
        Atrial fibrillation Better Care (ABC) pathway adherent care improves outcomes in Chinese patients with atrial fibrillation: a report from the nationwide optimal thromboprophylaxis in elderly chinese patients with atrial fibrillation (ChiOTEAF) registry.
        JACC Asia. 2022; Epub ahead of print (doi.org/)https://doi.org/10.1016/j.jacasi.2022.01.007
        • Guo Y.
        • Lane D.A.
        • Wang L.
        • Zhang H.
        • Wang H.
        • Zhang W.
        • et al.
        Mobile health technology to improve care for patients with atrial fibrillation.
        J Am Coll Cardiol. 2020; 75: 1523-1534
        • Guo Y.
        • Guo J.
        • Shi X.
        • Yao Y.
        • Sun Y.
        • Xia Y.
        • et al.
        Mobile health technology-supported atrial fibrillation screening and integrated care: a report from the mAFA-II trial long-term extension cohort.
        Eur J Intern Med. 2020; 82: 105-111
        • Potpara T.S.
        • Lip G.Y.H.
        • Blomstrom-Lundqvist C.
        • Boriani G.
        • Van Gelder I.C.
        • Heidbuchel H.
        • et al.
        The 4S-AF scheme (stroke risk; symptoms; severity of burden; substrate): a novel approach to in-depth characterization (rather than classification) of atrial fibrillation.
        Thromb Haemost. 2021; 121: 270-278
        • Guo Y.
        • Imberti J.F.
        • Kotalczyk A.
        • Wang Y.
        • Lip G.Y.H.
        Investigators CR. 4S-AF scheme and ABC pathway guided management improves outcomes in atrial fibrillation patients.
        Eur J Clin Invest. 2022; Epub ahead of print: e13751https://doi.org/10.1111/eci.13751
        • Hendriks J.M.
        • de Wit R.
        • Crijns H.J.
        • Vrijhoef H.J.
        • Prins M.H.
        • Pisters R.
        • et al.
        Nurse-led care vs. usual care for patients with atrial fibrillation: results of a randomized trial of integrated chronic care vs. routine clinical care in ambulatory patients with atrial fibrillation.
        Eur Heart J. 2012; 33: 2692-2699
        • Wijtvliet E.
        • Tieleman R.G.
        • van Gelder I.C.
        • Pluymaekers N.
        • Rienstra M.
        • Folkeringa R.J.
        • et al.
        Nurse-led vs. usual-care for atrial fibrillation.
        Eur Heart J. 2020; 41: 634-641