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REVIEW

Digital tools and scores for estimating the risk of stroke and bleeding in atrial fibrillation

Kyra Dingle1† ,  Jeffrey E. Jones1† ,  Dhruvil Ashishkumar Patel2 ,  Camila Trejo-Paredes3 ,  Lynda E. Rosenfeld3 ,  Jiun-Ruey Hu3,4*
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1 School of Medicine, University of California Irvine, Irvine, California, United States of America
2 Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
3 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
4 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
Brain & Heart 2024, 2(3), 3068 https://doi.org/10.36922/bh.3068
Submitted: 1 March 2024 | Accepted: 29 May 2024 | Published: 7 August 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Atrial fibrillation (AF) is a significant risk factor for cardioembolic stroke; however, therapeutic anticoagulation for stroke prevention in patients with AF also increases the risk of bleeding. Over the past two decades, extensive efforts have focused on refining patient stratification into risk categories to guide the selection of anticoagulant therapy. Various scores have been developed to estimate stroke risk in patients with AF, including CHADS2, Framingham, CHA2DS2-VASc, ATRIA, ABC, GARFIELD-AF, and IMRS-VASc, with CHA2DS2-VASc being the most widely utilized. Similarly, scores such as HEMORR2HAGES, HAS-BLED, ORBIT, ATRIA, GARFIELD-AF, and the newly introduced DOAC are utilized to estimate bleeding risk, with HAS-BLED being predominant. In recent years, numerous digital tools have been developed to assist physicians and patients in visualizing the risk of stroke and bleeding in an interactive manner, to strengthen the use of evidence-based medicine, and to facilitate shared decisionmaking. These tools include the American College of Cardiology’s AnticoagEvaluator app, Mayo Clinic Anticoagulation Choice Decision Aid, Stroke Prevention in Atrial Fibrillation Risk Tool (SPARCtool), GARFIELD-AF Risk Calculator, and CardioSmart Atrial Fibrillation and Bleeding Risk Calculator. This review explores the evolution of these risk scores, evaluating their merits and drawbacks while highlighting common variables across multiple risk scores. In addition, it describes the landscape of novel digital tools designed for decision-making, offering insights from the perspective of physician users.

Keywords
Atrial fibrillation
Anticoagulation
Bleeding
Stroke
Digital tools
Risk score
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
References
  1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and stroke statistics-2023 update: A report from the American heart association. Circulation. 2023;147(8):e93-e621. doi: 10.1161/CIR.0000000000001123

 

  1. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X. Estimates of current and future incidence and prevalence of atrial fibrillation in the U.S. adult population. Am J Cardiol. 2013;112(8):1142-1147. doi: 10.1016/j.amjcard.2013.05.063

 

  1. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham Heart Study: A cohort study. Lancet Lond Engl. 2015;386(9989):154-162. doi: 10.1016/S0140-6736(14)61774-8

 

  1. Emdin CA, Wong CX, Hsiao AJ, et al. Atrial fibrillation as risk factor for cardiovascular disease and death in womencompared with men: Systematic review and meta-analysis of cohort studies. BMJ. 2016;532:h7013. doi: 10.1136/bmj.h7013

 

  1. Lip GYH, Andreotti F, Fauchier L, et al. Bleeding risk assessment and management in atrial fibrillation patients. Executive Summary of a Position Document from the European Heart Rhythm Association [EHRA], endorsed by the European Society of Cardiology [ESC] Working Group on Thrombosis. Thromb Haemost. 2011;106(6):997-1011. doi: 10.1160/TH11-10-0690

 

  1. McIntyre WF, Benz AP, Becher N, et al. Direct oral anticoagulants for stroke prevention in patients with devicedetected atrial fibrillation: A study-level meta-analysis of the NOAH-AFNET 6 and ARTESiA Trials. Circulation. 2023;149(13):981-988. doi: 10.1161/CIRCULATIONAHA.123.067512

 

  1. Agarwal S, Hachamovitch R, Menon V. Current trialassociated outcomes with warfarin in prevention of stroke in patients with nonvalvular atrial fibrillation: A meta-analysis. Arch Intern Med. 2012;172(8):623-631; discussion 631-633. doi: 10.1001/archinternmed.2012.121

 

  1. van der  Endt  VHW,  Milders  J,  Penning  de  Vries  BBL, et  al.  Comprehensive  comparison  of  stroke  risk  score performance:   A   systematic   review   and   meta-analysis among 6 267 728 patients with atrial fibrillation. Europace. 2022;24(11):1739-1753. doi: 10.1093/europace/euac096

 

  1. Hinton RC, Kistler JP, Fallon JT, Friedlich AL, Fisher CM. Influence of  etiology  of  atrial  fibrillation  on  incidence  of systemic embolism. Am J Cardiol. 1977;40(4):509-513. doi: 10.1016/0002-9149(77)90064-9

 

  1. Wolf PA, Abbott RD, Kannel WB. Atrial fibrillation: A major contributor to stroke in the elderly. The Framingham Study. Arch Intern Med. 1987;147(9):1561-1564.

 

  1. Benjamin EJ, Levy D, Vaziri SM, D’Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a  population-based  cohort:  The  Framingham  heart  study. JAMA. 1994;271(11):840-844.doi: 10.1001/jama.1994.03510350050036

 

  1. Hart RG,  Pearce  LA,  McBride  R,  Rothbart  RM,  Asinger RW. Factors associated with ischemic stroke during aspirin therapy in atrial fibrillation: Analysis of 2012 participants in  the  SPAF  I-III  clinical  trials.  The  Stroke  Prevention in    Atrial    Fibrillation    (SPAF)  Investigators. Stroke. 1999;30(6):1223-1229. doi: 10.1161/01.str.30.6.1223

 

  1. Stroke Prevention   in   Atrial   Fibrillation   Investigators. Stroke prevention in atrial fibrillation study. Final results. Circulation. 1991;84(2):527-539. doi: 10.1161/01.cir.84.2.527

 

  1. Stroke Prevention   in   Atrial   Fibrillation   Investigators. Warfarin versus aspirin for prevention of thromboembolism in atrial fibrillation: Stroke Prevention in Atrial Fibrillation II Study. Lancet. 1994;343(8899):687-691. doi: 10.1016/S0140-6736(94)91577-6

                         

  1. Stroke Prevention   in   Atrial   Fibrillation   Investigators. Adjusted-dose   warfarin   versus   low-intensity,   fixed-dose warfarin  plus  aspirin  for  high-risk  patients  with  atrial fibrillation:   Stroke   Prevention   in   Atrial   Fibrillation   III randomised clinical trial. Lancet. 1996;348(9028):633-638. doi: 10.1016/S0140-6736(96)03487-3

 

  1. Risk factors   for   stroke   and   efficacy   of   antithrombotic therapy   in   atrial   fibrillation:   Analysis   of   pooled   data from  five  randomized  controlled  trials.  Arch  Intern  Med. 1994;154(13):1449-1457. doi: 10.1001/archinte.1994.00420130036007

 

  1. Gage BF, Waterman AD, Shannon W, Boechler M, Rich MW, Radford MJ. Validation of clinical classification schemes for predicting stroke: Results from the national registry of atrial fibrillation. JAMA. 2001;285(22):2864-2870. doi: 10.1001/jama.285.22.2864

 

  1. Fuster V, Rydén LE, Cannom DS, et al. 2011 ACCF/AHA/ HRS focused updates incorporated into the ACC/AHA/ESC 2006 guidelines for the management of patients with atrial fibrillation: A report of the American College of Cardiology Foundation/American  Heart  Association  Task  Force  on practice guidelines. Circulation. 2011;123(10):e269-e367. doi: 10.1161/CIR.0b013e318214876d

 

  1. Wang TJ,  Massaro  JM,  Levy  D,  et  al.  A  risk  score  for predicting  stroke  or  death  in  individuals  with  new-onset atrial fibrillation in the community: The Framingham Heart Study. JAMA. 2003;290(8):1049-1056. doi: 10.1001/jama.290.8.1049

 

  1. Gage BF,   van   Walraven   C,   Pearce   L,   et   al.   Selecting patients  with  atrial  fibrillation  for  anticoagulation:  Stroke risk  stratification  in  patients  taking  aspirin.  Circulation. 2004;110(16):2287-2292. doi: 10.1161/01.CIR.0000145172.55640.93

 

  1. Rietbrock S, Heeley E, Plumb J, van Staa T. Chronic atrial fibrillation: Incidence, prevalence, and prediction of stroke using the Congestive heart failure, Hypertension, Age >75, Diabetes  mellitus,  and  prior  Stroke  or  transient  ischemic attack  (CHADS2)  risk  stratification  scheme.  Am  Heart  J. 2008;156(1):57-64. doi: 10.1016/j.ahj.2008.03.010

 

  1. Lip GYH, Nieuwlaat R, Pisters R, Lane DA, Crijns HJGM. 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(2):263-272. doi: 10.1378/chest.09-1584

 

  1. Friberg L,   Rosenqvist   M,   Lip   GYH.   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(12):1500-1510. doi: 10.1093/eurheartj/ehr488

 

  1. Chen LY,  Norby  FL,  Chamberlain  AM,  et  al.  CHA2DS2- VASc  score  and  stroke prediction  in  atrial  fibrillation  in whites, blacks, and hispanics. Stroke. 2019;50(1):28-33. doi: 10.1161/STROKEAHA.118.021453

 

  1. Olesen JB,  Lip  GYH,  Hansen  ML,  et  al.  Validation  of risk   stratification   schemes   for   predicting   stroke   and thromboembolism   in   patients   with   atrial   fibrillation: Nationwide cohort study. BMJ. 2011;342:d124. doi: 10.1136/bmj.d124

 

  1. European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, 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(19):2369-2429. doi: 10.1093/eurheartj/ehq278

 

  1. January CT,  Wann  LS,  Alpert  JS,  et  al.  2014  AHA/ACC/ HRS guideline for the management of patients with atrial fibrillation: Executive summary: A report of the American College  of  Cardiology/American  Heart  Association  Task Force on practice guidelines and the Heart Rhythm Society. Circulation. 2014;130(23):2071-2104. doi: 10.1161/CIR.0000000000000040

 

  1. Mulder BA, van Veldhuisen DJ, Rienstra M. What should the C  (“congestive  heart  failure”)  represent  in  the  CHA2 DS2 -VASc score? Eur J Heart Fail. 2020;22(8):1294-1297. doi: 10.1002/ejhf.1946

 

  1. Ponikowski P,  Voors  AA,  Anker  SD,  et  al.  2016  ESC Guidelines  for  the  diagnosis  and  treatment  of  acute  and chronic heart failure: The Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society  of  Cardiology  (ESC)  Developed  with  the  special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2016;37(27):2129-2200. doi: 10.1093/eurheartj/ehw128

 

  1. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ ACCP/HRS guideline  for  the  diagnosis  and  management of  atrial  fibrillation:  A  report  of  the  American  college  of cardiology/American  Heart  association  joint  committee on clinical practice guidelines. Circulation. 2024;149(1):e1- e156. doi: 10.1161/CIR.0000000000001193

 

  1. Kotecha D, Chudasama R, Lane DA, Kirchhof P, Lip GYH. Atrial fibrillation  and  heart  failure  due  to  reduced  versus preserved ejection fraction: A systematic review and meta- analysis  of  death  and  adverse  outcomes.  Int  J  Cardiol. 2016;203:660-666. doi: 10.1016/j.ijcard.2015.10.220

 

  1. Ariyaratnam JP,  Lau  DH,  Sanders  P,  Kalman  JM.  Atrial fibrillation and heart failure: Epidemiology, pathophysiology, prognosis,   and   management.   Card   Electrophysiol   Clin.  2021;13(1):47-62. doi: 10.1016/j.ccep.2020.11.004

 

  1. Singer DE, Chang Y, Borowsky LH, 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;2(3):e000250. doi: 10.1161/JAHA.113.000250

 

  1. Go AS,  Hylek  EM,  Borowsky  LH,  Phillips  KA,  Selby  JV, Singer DE. Warfarin use among ambulatory patients with nonvalvular atrial fibrillation: The anticoagulation and risk atrial fibrillation (ATRIA) study. Ann Intern Med. 1999;131(12):927-934. doi: 10.7326/0003-4819-131-12-199912210-00004

 

  1. Hijazi Z, Oldgren J, Siegbahn A, Granger CB, Wallentin L. Biomarkers in atrial fibrillation: A clinical review. Eur Heart J. 2013;34(20):1475-1480. doi: 10.1093/eurheartj/eht024

 

  1. Hijazi Z,  Lindbäck  J,  Alexander  JH,  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(20):1582-1590. doi: 10.1093/eurheartj/ehw054

 

  1. Berg DD, Ruff CT, Jarolim P, 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(6):760-771. doi: 10.1161/CIRCULATIONAHA.118.038312

 

  1. Fox KAA,   Lucas   JE,   Pieper   KS,   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;7(12):e017157. doi: 10.1136/bmjopen-2017-017157

 

  1. Shin SY,  Han  SJ,  Kim  JS,  et  al.  Identification  of  markers associated   with  development   of   stroke   in   “clinically low-risk”  atrial  fibrillation  patients.  J  Am Heart  Assoc. 2019;8(21):e012697. doi: 10.1161/JAHA.119.012697

 

  1. Vasunilashorn S, Crimmins EM, Kim JK, et al. Blood lipids, infection, and  inflammatory  markers  in  the  Tsimane  of Bolivia. Am J Hum Biol. 2010;22(6):731-740. doi: 10.1002/ajhb.21074

 

  1. Johnston SC,  Rothwell  PM,  Nguyen-Huynh  MN,  et  al. Validation  and  refinement  of  scores  to  predict  very  early stroke  risk  after  transient  ischaemic  attack.  Lancet  Lond Engl. 2007;369(9558):283-292. doi: 10.1016/S0140-6736(07)60150-0

 

  1. Claxton JS, MacLehose RF, Lutsey PL, et al. A new model to predict ischemic stroke in patients with atrial fibrillation using warfarin or direct oral anticoagulants. Heart Rhythm. 2019;16(6):820-826. doi: 10.1016/j.hrthm.2018.12.005

 

  1. Graves KG,  May  HT,  Knowlton  KU,  et  al.  Improving CHA2DS2-VASc   stratification   of non-fatal   stroke   and mortality  risk  using  the  Intermountain  Mortality  Risk Score  among patients  with  atrial  fibrillation.  Open  Heart. 2018;5(2):e000907. doi: 10.1136/openhrt-2018-000907

 

  1. Horne BD,  Jacobs  V,  May  HT,  Graves  KG,  Bunch  TJ. Augmented intelligence decision tool for stroke prediction combines     factors     from     CHA2DS2-VASc     and     the intermountain risk score for patients with atrial fibrillation. J Cardiovasc Electrophysiol. 2019;30(9):1452-1461. doi: 10.1111/jce.13999

 

  1. Engelsgjerd EK,  Benziger  CP,  Horne  BD.  Validation  of the intermountain risk score and get with the guidelines- heart  failure  score  in  predicting  mortality.  Open  Heart. 2021;8(2):e001722. doi: 10.1136/openhrt-2021-001722

 

  1. Esteve-Pastor MA, Roldán V, Rivera-Caravaca JM, Ramírez- Macías I,  Lip  GYH,  Marín  F. The  use  of  biomarkers  in clinical management guidelines: A critical appraisal. Thromb Haemost.2019;119(12):1901-1919. doi: 10.1055/s-0039-1696955

 

  1. Rivera-Caravaca JM,  Marín  F,  Vilchez  JA,  et  al.  Refining stroke  and  bleeding prediction  in  atrial  fibrillation  by adding consecutive biomarkers to clinical risk scores. Stroke. 2019;50(6):1372-1379. doi: 10.1161/STROKEAHA.118.024305

 

  1. Hu JR, Abdullah A, Nanna MG, Soufer R. The brain-heart axis: Neuroinflammatory interactions   in   cardiovascular disease. Curr Cardiol Rep. 2023;25(12):1745-1758. doi: 10.1007/s11886-023-01990-8

 

  1. Kamel H,   Elkind   MSV,   Bhave   PD,   et   al.   Paroxysmal supraventricular tachycardia and the risk of ischemic stroke. Stroke. 2013;44(6):1550-1554. doi: 10.1161/STROKEAHA.113.001118

 

  1. Kamel H,   Okin   PM,   Elkind   MSV,   Iadecola   C.   Atrial fibrillation  and  mechanisms  of  stroke:  Time  for  a  new model. Stroke. 2016;47(3):895-900. doi: 10.1161/STROKEAHA.115.012004

 

  1. Maheshwari A,  Norby  FL,  Roetker  NS,  et  al.  Refining prediction   of   atrial   fibrillation-related   stroke   using   the P2-CHA2DS2-VASc score. Circulation. 2019;139(2):180-191. doi: 10.1161/CIRCULATIONAHA.118.035411

 

  1. Atrial Fibrillation   Investigators:   Atrial   Fibrillation   A Anticoagulation Study; European Atrial Fibrillation Study; Stroke Prevention in Atrial Fibrillation Study; Boston Area Anticoagulation Trial for Atrial Fibrillation Study; Canadian Atrial  Fibrillation  Study;  Veterans  Affairs  Prevention  in Atrial  Fibrillation  Study.  Echocardiographic  predictors  of stroke in patients with atrial fibrillation: A prospective study of  1066  patients  from  3 clinical  trials.  Arch  Intern  Med. 1998;158(12):1316-1320. doi: 10.1001/archinte.158.12.1316

 

  1. Yaghi S,   Moon   YP,   Mora-McLaughlin   C,   et   al.   Left atrial  enlargement  and  stroke  recurrence:  The  Northern Manhattan Stroke Study. Stroke. 2015;46(6):1488-1493. doi: 10.1161/STROKEAHA.115.008711

 

  1. Liao JN, Chao TF, Kuo JY, et al. Global left atrial longitudinal strain using   3-beat   method   improves   risk   prediction of  stroke  over  conventional  echocardiography  in  atrial fibrillation. Circ Cardiovasc Imaging. 2020;13(8):e010287. doi: 10.1161/CIRCIMAGING.119.010287

 

  1. Melzi P, Tolosana R, Cecconi A, et al. Analyzing artificial intelligence systems for the prediction of atrial fibrillation from   sinus-rhythm   ECGs   including   demographics   and feature visualization. Sci Rep. 2021;11(1):22786. doi: 10.1038/s41598-021-02179-1

 

  1. Schulman S,   Kearon   C,   Subcommittee   on   Control   of Anticoagulation   of   the   Scientific   and   Standardization Committee  of  the  International  Society  on  Thrombosis and  Haemostasis.  Definition  of  major  bleeding  in  clinical investigations of antihemostatic medicinal products in non- surgical patients. J Thromb Haemost. 2005;3(4):692-694. doi: 10.1111/j.1538-7836.2005.01204.x

 

  1. Gage BF,  Yan  Y,  Milligan  PE,  et  al.  Clinical  classification schemes   for   predicting   hemorrhage:   Results   from   the National Registry of Atrial Fibrillation (NRAF). Am Heart J. 2006;151(3):713-719. doi: 10.1016/j.ahj.2005.04.017

 

  1. Pisters R, Lane DA, Nieuwlaat R, de Vos CB, Crijns HJGM, Lip GYH. 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(5):1093-1100. doi: 10.1378/chest.10-0134

 

  1. Zhu W, He W, Guo L, Wang X, Hong K. The HAS-BLED score for predicting major bleeding risk in anticoagulated patients  with  atrial  fibrillation:  A  systematic  review  and meta-analysis. Clin Cardiol. 2015;38(9):555-561. doi: 10.1002/clc.22435

 

  1. Fang MC,  Go  AS,  Chang  Y,  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(4):395-401. doi: 10.1016/j.jacc.2011.03.031

 

  1. Apostolakis S,  Lane  DA,  Guo  Y,  Buller  H,  Lip  GYH. Performance of the HEMORR(2)HAGES, ATRIA, and HAS- BLED bleeding risk-prediction scores in patients with atrial fibrillation  undergoing  anticoagulation:  The  AMADEUS (evaluating  the  use  of  SR34006  compared  to  warfarin  or acenocoumarol  in  patients  with  atrial  fibrillation)  study. J Am Coll Cardiol. 2012;60(9):861-867. doi: 10.1016/j.jacc.2012.06.019

 

  1. Roldán V,  Marín  F,  Fernández  H,  et  al.  Predictive  value of  the  HAS-BLED  and  atrial  fibrillation  receiving  anticoagulant  therapy.  Chest. 2013;143(1):179-184. doi: 10.1378/chest.12-0608

 

  1. O’Brien EC,  Simon  DN,  Thomas  LE,  et  al.  The  ORBIT bleeding  score:  A  simple  bedside  score  to  assess  bleeding risk in atrial fibrillation. Eur Heart J. 2015;36(46):3258-3264. doi: 10.1093/eurheartj/ehv476

 

  1. Patel MR, Mahaffey KW, Garg J, et al. Rivaroxaban versus warfarin in  nonvalvular  atrial  fibrillation.  N  Engl  J  Med. 2011;365(10):883-891. doi: 10.1056/NEJMoa1009638

 

  1. Senoo K, Proietti M, Lane DA, Lip GYH. Evaluation of the HAS-BLED, ATRIA,  and  ORBIT  bleeding  risk  scores  in patients with atrial fibrillation taking warfarin. Am J Med. 2016;129(6):600-607. doi: 10.1016/j.amjmed.2015.10.001

 

  1. Aggarwal R,  Ruff  CT,  Virdone  S,  et  al.  Development  and validation  of  the  DOAC = score:  A  novel  bleeding  risk prediction tool for patients with atrial fibrillation on direct- acting  Oral  anticoagulants.  Circulation.  2023;148(12):936- 946. doi: 10.1161/CIRCULATIONAHA.123.064556

 

  1. Hindricks G,   Potpara   T,   Dagres   N,   et   al.   2020   ESC Guidelines  for  the  diagnosis  and  management  of  atrial fibrillation  developed  in  collaboration  with  the  European Association  for  Cardio-Thoracic  Surgery  (EACTS):  The Task  Force  for  the  diagnosis and  management  of  atrial fibrillation  of  the  European  Society  of  Cardiology  (ESC) Developed  with  the  special  contribution  of  the  European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J. 2021;42(5):373-498. doi: 10.1093/eurheartj/ehaa612

 

  1. Chao TF, Joung B, Takahashi Y, et al. 2021 focused update consensus guidelines  of  the  Asia  pacific  heart  rhythm society on stroke prevention in atrial fibrillation: Executive Summary. Thromb Haemost. 2022;122(1):20-47. doi: 10.1055/s-0041-1739411

 

  1. Steinberg BA,  Ballew  NG,  Greiner  MA,  et  al.  Ischemic and  bleeding  outcomes  in  patients  with  atrial  fibrillation and  contraindications  to  oral  anticoagulation.  JACC  Clin Electrophysiol. 2019;5(12):1384-1392. doi: 10.1016/j.jacep.2019.07.011

 

  1. CHADS₂ Score for Atrial Fibrillation Stroke Risk. MDCalc. Available from:  https://www.mdcalc.com/calc/40/chads2- score-atrial-fibrillation-stroke-risk     [Last accessed on 2024 Feb 28].

 

  1. CHA₂DS₂-VASc Score  for  Atrial  Fibrillation  Stroke  Risk. MDCalc.     Available     from:

    https://www.mdcalc.com/calc/801/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk [Last accessed on 2024 Feb 28].

 

  1. ATRIA Stroke Risk Score. MDCalc. Available from: https:// www.mdcalc.com/calc/1842/atria-stroke-risk-score     [Last accessed on 2024 Feb 28].

 

  1. GARFIELD-AF. Available  from:  https://www.mdcalc.com/ calc/10504/garfield-af [Last accessed on 2024 Feb 28].

 

  1. HEMORR₂HAGES Score for Major Bleeding Risk. MDCalc. Available from: https://www.mdcalc.com/calc/1785/ hemorr2hages-score-major-bleeding-risk [Last accessed on 2024 Feb 28].

 

  1. HAS-BLED Score for Major Bleeding Risk. MDCalc. https:// www.mdcalc.com/calc/807/has-bled-score-major-bleeding- risk [Last accessed on 2024 Feb 28].

 

  1. ATRIA Bleeding Risk Score. MDCalc. Available from: https:// www.mdcalc.com/calc/1718/atria-bleeding-risk-score [Last accessed on 2024 Feb 28].

 

  1. ORBIT Bleeding Risk Score for Atrial Fibrillation. MDCalc. Available from:] https://www.mdcalc.com/calc/10227/orbit- bleeding-risk-score-atrial-fibrillation   [Last   accessed on 2024 Feb 28].

 

  1. Noseworthy PA, Branda ME, Kunneman M, et al. Effect of shared decision-making for stroke prevention on treatment adherence  and  safety  outcomes  in  patients  with  atrial fibrillation: A randomized clinical trial. J Am Heart Assoc. 2022;11(2):e023048. doi: 10.1161/JAHA.121.023048

 

  1. Kunneman M, Branda ME, Hargraves IG, et al. Assessment of shared decision-making for stroke prevention in patients with  atrial  fibrillation:  A  randomized  clinical  trial.  JAMA Intern Med. 2020;180(9):1215-1224. doi: 10.1001/jamainternmed.2020.2908

 

  1. Loewen PS,  Bansback  N,  Hicklin  J,  et  al.  Evaluating  the effect of a patient decision aid for atrial fibrillation stroke prevention therapy. Ann Pharmacother. 2019;53(7):665-674. doi: 10.1177/1060028019828420

 

  1. Apenteng PN, Prieto-Merino D, Hee SW, Caleyachetty R, Fitzmaurice DA. Optimising prediction of mortality, stroke, and  major  bleeding  for  patients  with  atrial  fibrillation: Validation  of  the  GARFIELD-AF  tool  in  UK  primary care electronic records. Br J Gen Pract J R Coll Gen Pract. 2023;73(736):e816-e824. doi: 10.3399/BJGP.2023.0082

 

  1. Irwig L, Irwig J, Trevena L, Sweet M. Relative risk, relative and absolute  risk  reduction,  number  needed  to  treat  and confidence intervals. In: Smart Health Choices: Making Sense of Health Advice. Hammersmith Press; 2008. Available from: https://www.ncbi.nlm.nih.gov/books/NBK63647 [Last accessed on 2024 Feb 29].

 

  1. AnticoagEvaluator App.  American  College  of  Cardiology. Available  from:  https://www.acc.org/http%3a%2f%2fwww. acc.org%2fanticoagevaluator [Last accessed on 2024 Feb 29].

 

  1. Zeballos-Palacios CL, Hargraves IG, Noseworthy PA, et al. Developing a conversation aid to support shared decision making:  reflections  on  designing  anticoagulation  choice. Mayo Clin Proc. 2019;94(4):686-696. doi: 10.1016/j.mayocp.2018.08.030

 

  1. Kunneman M, Branda ME, Noseworthy PA, et al. Shared decision making for stroke prevention in atrial fibrillation: Study  protocol  for  a  randomized  controlled  trial.  Trials. 2017;18(1):443. doi: 10.1186/s13063-017-2178-y

 

  1. Anticoagulation Choice.  Care  that  Fits.;  2020.  Available from:    https://carethatfits.org/anticoagulation-choice   [Last accessed on 2024 May 05].

 

  1. Fox CS, Pencina MJ, Wilson PWF, Paynter NP, Vasan RS, Lifetime risk of  cardiovascular  disease among individuals with and without diabetes stratified by besity status in the Framingham heart study. Diabetes Care. doi: 10.2337/dc08-0025

 

  1. Sprague D,  Loewen  P.  Bedside  calculation  of  stroke  risk in patients with atrial fibrillation. Am J Health-Syst Pharm AJHP Off J Am Soc Health-Syst Pharm. 2003;60(5):427-429. doi: 10.1093/ajhp/60.5.427

 

  1. Stanford Guide  to  AFib  Stroke  Prevention.  Available  from: https://afibguide.com [Last accessed on 2024 Feb 28].

 

  1. A to Z Summary Results - Patient Decision Aids - Ottawa Hospital Research    Institute.    Available    from:    https:// decisionaid.ohri.ca/Azsumm.php?ID=1043  [Last  accessed on 2024 Feb 28]

 

  1. Atrial Fibrillation:  Stroke  Prevention  -  Colorado  Program for   Patient   Centered   Decisions.  Available  from:  https:// decisionaid.org/icd/atrial-fibrillation  [Last  accessed on 2024 Feb 28].
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing
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