Importance of risk reassessment in patients with atrial fibrillation in guidelines: Assessing risk as a dynamic process

Publication date: Available online 2 February 2019Source: Canadian Journal of CardiologyAuthor(s): Ting-Yung Chang, Gregory Y.H. Lip, Shih-Ann Chen, Tze-Fan ChaoAbstractThe appropriate use of oral anticoagulants (OACs) for stroke prevention in atrial fibrillation (AF) relies on the convenient and accurate stroke risk prediction scheme, namely the CHA2DS2-VASc score. Since AF patients would become older and accumulate more comorbidities, their risk (for example, as reflected by the CHA2DS2-VASc scores) are not static and could increase over time. The available data demonstrated that follow-up and delta CHA2DS2-VASc scores perform better than the baseline CHA2DS2-VASc score in the prediction of ischemic stroke. Around 90% of initially low-risk patients would have a delta CHA2DS2-VASc score > 1 before the occurrence of ischemic stroke.Apart from stroke risk, the bleeding risk of AF patients is also highly dynamic. For example, the accuracies of the follow-up or delta HAS-BLED score in the prediction of major bleeding was significantly higher than that of the baseline HAS-BLED score. Most importantly, the risk of stroke and major bleeding was higher within several months after patients had a change (an increase) in their stroke or bleeding risk scores.Therefore, risk profiles of AF patients should be regularly reassessed, so that OACs could be prescribed in a timely manner once patients are no longer low risk for stroke and modifiable risk factors for bleeding could be corrected....
Source: Canadian Journal of Cardiology - Category: Cardiology Source Type: research