Solutions to Reduce Cardiovascular Events in Patients with Atrial Fibrillation

AF is the most common sustained cardiac rhythm disorder and an established risk factor for ischemic stroke. Ischemic strokes which occur in patients with AF are particularly severe and disabling. In addition, stroke recurrence is more common in patients with AF compared with those without it. Previous cerebrovascular events, age, hypertension, diabetes, and heart failure are risk factors for stroke in patients with AF. Various risk stratification schemes have been developed to quantify the risk for stroke in patients with AF. Currently, the most frequently used schemes to assess stroke risk in patients with AF are CHADS₂, the ACC/AHA/ESC and American College of Chest Physicians (ACCP) schemes. Current risk scores are largely derived from risk factors identified from clinical trials and many potential risk factors have not been properly considered. Consequently, the stroke risk in many patients could be underestimated, and these patients could receive a suboptimal antithrombotic prophylaxis. There is substantial evidence for the benefit of vitamin K antagonists (VKA) in preventing stroke and reducing mortality. Novel oral anticoagulants are available for stroke prevention in patients with AF which overcome some of the difficulties associated with VKA. The introduction of novel oral anticoagulants in clinical practice and the advances in identifying patients at risk of stroke together may overcome many of the difficulties in providing effective stroke prevention for patients with AF.