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Stroke Prevention, Evaluation of Bleeding Risk and Anticoagulant Treatment Management in Atrial Fibrillation Contemporary International GuidelinesShort Title: International AF GuidelinesMarco Proietti1,2 MD, Deirdre A. Lane3,4 PhD, Giuseppe Boriani5* MD PhD, Gregory Y.H. Lip3,4* MD1Istituto di Ricerche Farmacologiche Mario Negri IRCCS, Milan, Italy; 2Department of Internal Medicine and Medical Specialties, Sapienza-University of Rome, Rome, Italy; 3Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom; 4Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark; 5Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.*joint senior authors.Corresponding Author:Professor Gregory YH Lip: E-mail: gregory.lip@liverpool.ac.ukSUMMARYIn contemporary international guidelines on the management of atrial fibrillation, there is general agreement about the baseline evaluation of thromboembolic and bleeding risk and preferential use of NOACs. Notwithstanding the broad agreement, more data are needed about management of specific AF sub-populations. The need for an integrated approach and holistic management is highlighted in the more recently published guidelines.ABSTRACTIn recent years the management of AF patients has progressively and substantially changed due to the introduction of new treatments and the availability of new data regarding the epidemiology and clinical management of these patients. In the last two years alone, there have been seven new guidelines or guideline updates that have been published, introducing new recommendations and significantly revising previously published ones. Two updates for Canadian guidelines were published in 2016 and 2018, while guidelines from the European Society of Cardiology in 2016, Asia Pacific Heart Rhythm Society in 2017, National Heart Foundation of Australia/Cardiac Society of Australia and New Zealand, American College of Chest Physicians and Korean Heart Rhythm Society in 2018 have been published. This narrative review aims to provide a comparison of these contemporary international guidelines, with particular attention on the evaluation of thromboembolic and bleeding risks and management of OAC therapy. From the analysis of contemporary guidelines on the management of atrial fibrillation, a general agreement is evident about the baseline evaluation of thromboembolic and bleeding risk, as well as a preference for the use of NOACs. Also, regarding the concomitant use of OAC and antiplatelet drugs in patients with acute coronary syndromes, undergoing elective percutaneous coronary intervention, catheter ablation and cardioversion procedures, all the guidelines agree on the general principles and are supported by evidence. More data are still needed to better substantiate recommendations for specific AF sub-populations. The need for an integrated approach and holistic management is highlighted in the more recently published guidelines.IntroductionIn the last ten years, clinical practice on stroke prevention in patients with atrial fibrillation (AF) has markedly changedADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1160/TH16-11-0876","ISSN":"2567-689X","PMID":"28597905","abstract":"Concepts and our approaches to stroke prevention in atrial fibrillation (AF) have changed markedly over the last decade. There has been an evolution over the approach to stroke and bleeding risk assessment, as well as new treatment options. An increasing awareness of AF has led to calls to improve the detection of and population screening for AF. Stroke and bleeding risk assessment continues to evolve, and the ongoing debate on balance between simplicity and practicality, against precision medicine will continue. In this review article, we provide an overview of past, present and the (likely) future concepts and approaches to stroke prevention in AF. We propose three simple steps (the Birmingham '3-step') that offers a practical management pathway to help streamline and simplify decision-making for stroke prevention in patients with AF.","author":[{"dropping-particle":"","family":"Lip","given":"Gregory","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Caterina","given":"Raffaele","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Potpara","given":"Tatjana S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"7","issued":{"date-parts":[["2017","6","28"]]},"page":"1230-1239","title":"Stroke prevention in atrial fibrillation: Past, present and future. Comparing the guidelines and practical decision-making.","type":"article-journal","volume":"117"},"uris":[""]}],"mendeley":{"formattedCitation":"¹","plainTextFormattedCitation":"1","previouslyFormattedCitation":"¹"},"properties":{"noteIndex":0},"schema":""}1. The introduction of non-vitamin K antagonist oral anticoagulants (NOACs) as an alternative to the vitamin K antagonists (VKAs)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0140-6736(13)62343-0","ISSN":"1474-547X","PMID":"24315724","abstract":"BACKGROUND: Four new oral anticoagulants compare favourably with warfarin for stroke prevention in patients with atrial fibrillation; however, the balance between efficacy and safety in subgroups needs better definition. We aimed to assess the relative benefit of new oral anticoagulants in key subgroups, and the effects on important secondary outcomes. METHODS: We searched Medline from Jan 1, 2009, to Nov 19, 2013, limiting searches to phase 3, randomised trials of patients with atrial fibrillation who were randomised to receive new oral anticoagulants or warfarin, and trials in which both efficacy and safety outcomes were reported. We did a prespecified meta-analysis of all 71 683 participants included in the RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE AF-TIMI 48 trials. The main outcomes were stroke and systemic embolic events, ischaemic stroke, haemorrhagic stroke, all-cause mortality, myocardial infarction, major bleeding, intracranial haemorrhage, and gastrointestinal bleeding. We calculated relative risks (RRs) and 95% CIs for each outcome. We did subgroup analyses to assess whether differences in patient and trial characteristics affected outcomes. We used a random-effects model to compare pooled outcomes and tested for heterogeneity. FINDINGS: 42 411 participants received a new oral anticoagulant and 29 272 participants received warfarin. New oral anticoagulants significantly reduced stroke or systemic embolic events by 19% compared with warfarin (RR 0·81, 95% CI 0·73-0·91; p<0·0001), mainly driven by a reduction in haemorrhagic stroke (0·49, 0·38-0·64; p<0·0001). New oral anticoagulants also significantly reduced all-cause mortality (0·90, 0·85-0·95; p=0·0003) and intracranial haemorrhage (0·48, 0·39-0·59; p<0·0001), but increased gastrointestinal bleeding (1·25, 1·01-1·55; p=0·04). We noted no heterogeneity for stroke or systemic embolic events in important subgroups, but there was a greater relative reduction in major bleeding with new oral anticoagulants when the centre-based time in therapeutic range was less than 66% than when it was 66% or more (0·69, 0·59-0·81 vs 0·93, 0·76-1·13; p for interaction 0·022). Low-dose new oral anticoagulant regimens showed similar overall reductions in stroke or systemic embolic events to warfarin (1·03, 0·84-1·27; p=0·74), and a more favourable bleeding profile (0·65, 0·43-1·00; p=0·05), but significantly more ischaemic strokes (1·28, 1·02-1·60; p=0·045). INTERPRETATION: This meta-analysis is the first to inclu…","author":[{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Giugliano","given":"Robert P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Braunwald","given":"Eugene","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hoffman","given":"Elaine B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Deenadayalu","given":"Naveen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ezekowitz","given":"Michael D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weitz","given":"Jeffrey I","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lewis","given":"Basil S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkhomenko","given":"Alexander","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamashita","given":"Takeshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Antman","given":"Elliott M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet","id":"ITEM-1","issued":{"date-parts":[["2013","12"]]},"title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"²","plainTextFormattedCitation":"2","previouslyFormattedCitation":"²"},"properties":{"noteIndex":0},"schema":""}2, has significantly increased the prescription and use of oral anticoagulant (OAC) therapy in AF patients, as demonstrated by several epidemiological and observational studiesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw658","ISBN":"2076792171","ISSN":"0195-668X","PMID":"28110293","abstract":"Aim The aim of this study is to examine temporal trends in the use oral anticoagulants (OAC) as stroke prophylaxis in patients with atrial fibrillation (AF) and to examine factors associated with OAC initiation. From Danish nationwide registries, we identified patients diagnosed with AF at Danish hospitals and outpatient clin-ics between January 2005 and June 2015. OAC initiation was assessed from prescription fills ±180 days from date of AF diagnosis. We identified a total of 108 410 patients with newly diagnosed AF. Before 2010, 40–50% initiated OAC treatment. From 2010, OAC initiation rates increased (P < 0.0001 for trend) and by June 2015, 66.5% of the incident AF patients were initiated on OAC (74.5% increase since December 2009). Increased OAC prescription was especially seen among females and 'fragile' patients (age > 75 years and high risk of stroke). The increased OAC initiation was accompanied by introduction and increased uptake of the NOACs. By the end of the study, NOACs accounted for 72.5% of all OACs prescribed in newly diagnosed AF patients. OAC initiation was associ-ated with male gender, age 65–74 years, few comorbidities and increased risk of stroke. Since 2010, more incident AF patients in Denmark were initiated on OAC therapy with predominant NOAC pre-scription. The increase was pronounced among females, among patients at high risk of stroke, and among older patients.","author":[{"dropping-particle":"","family":"Gadsb?ll","given":"Kasper","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Staerk","given":"Laila","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Loldrup Fosb?l","given":"Emil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sindet-Pedersen","given":"Caroline","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gundlund","given":"Anna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory YH","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hilmar Gislason","given":"Gunnar","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bjerring Olesen","given":"Jonas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European heart journal","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2017","3"]]},"page":"899-906","title":"Increased use of oral anticoagulants in patients with atrial fibrillation: temporal trends from 2005 to 2015 in Denmark","type":"article-journal","volume":"38"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.jacc.2017.03.540","ISSN":"07351097","PMID":"28521884","abstract":"BACKGROUND Oral anticoagulation (OAC) with warfarin is underused for atrial fibrillation (AF). The availability of direct oral anticoagulants (DOACs) may improve overall OAC rates in AF patients, but a large-scale evaluation of their effects has not been conducted. OBJECTIVES This study assessed the effect of DOAC availability on overall OAC rates for nonvalvular AF. METHODS Between April 1, 2008 and September 30, 2014, we identified 655,000 patients with nonvalvular AF and a CHA2DS2-VASc score of >1 in the National Cardiovascular Data Registry PINNACLE registry. Temporal trends in overall OAC and individual warfarin and DOAC use were analyzed. Multivariable hierarchical logistic regression identified patient factors associated with OAC and DOAC use. Practice variation of OAC and DOAC use was also assessed. RESULTS Overall OAC rates increased from 52.4% to 60.7% among eligible AF patients (p for trend <0.01). Warfarin use decreased from 52.4% to 34.8% (p for trend <0.01), and DOAC use increased from 0% to 25.8% (p for trend <0.01). An increasing CHA2DS2-VASc score was associated with higher OAC use (odds ratio [OR]: 1.06; 95% confidence interval [CI]: 1.05 to 1.07), but with lower DOAC use (OR: 0.97; 95% CI: 0.96 to 0.98). Significant practice variation was present in OAC use (median odds ratio [MOR]: 1.52; 95% CI: 1.45 to 1.57) and in DOAC use (MOR: 3.58; 95% CI: 3.05 to 4.13). CONCLUSIONS Introduction of DOACs in routine practice was associated with improved rates of overall OAC use for AF, but significant gaps remain. In addition, there is significant practice-level variation in OAC and DOAC use.","author":[{"dropping-particle":"","family":"Marzec","given":"Lucas N.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wang","given":"Jingyan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shah","given":"Nilay D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Paul S.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ting","given":"Henry H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gosch","given":"Kensey L.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hsu","given":"Jonathan C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maddox","given":"Thomas M.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American College of Cardiology","id":"ITEM-2","issue":"20","issued":{"date-parts":[["2017","5"]]},"page":"2475-2484","title":"Influence of Direct Oral Anticoagulants on Rates of Oral Anticoagulation for Atrial Fibrillation","type":"article-journal","volume":"69"},"uris":["",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1136/heartjnl-2016-309832","ISSN":"1355-6037","PMID":"27647168","abstract":"OBJECTIVE We studied evolving antithrombotic therapy patterns in patients with newly diagnosed non-valvular atrial fibrillation (AF) and ≥1 additional stroke risk factor between 2010 and 2015. METHODS 39?670 patients were prospectively enrolled in four sequential cohorts in the Global Anticoagulant Registry in the FIELD-Atrial Fibrillation (GARFIELD-AF): cohort C1 (2010-2011), n=5500; C2 (2011-2013), n=11?662; C3 (2013-2014), n=11?462; C4 (2014-2015), n=11?046. Baseline characteristics and antithrombotic therapy initiated at diagnosis were analysed by cohort. RESULTS Baseline characteristics were similar across cohorts. Median CHA2DS2-VASc (cardiac failure, hypertension, age ≥75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)) score was 3 in all four cohorts. From C1 to C4, the proportion of patients on anticoagulant (AC) therapy increased by almost 15% (C1 57.4%; C4 71.1%). Use of vitamin K antagonist (VKA)±antiplatelet (AP) (C1 53.2%; C4 34.0%) and AP monotherapy (C1 30.2%; C4 16.6%) declined, while use of non-VKA oral ACs (NOACs)±AP increased (C1 4.2%; C4 37.0%). Most CHA2DS2-VASc ≥2 patients received AC, and this proportion increased over time, largely driven by NOAC prescribing. NOACs were more frequently prescribed than VKAs in men, the elderly, patients of Asian ethnicity, those with dementia, or those using non-steroidal anti-inflammatory drugs, and current smokers. VKA use was more common in patients with cardiac, vascular, or renal comorbidities. CONCLUSIONS Since NOACs were introduced, there has been an increase in newly diagnosed patients with AF at risk of stroke receiving guideline-recommended therapy, predominantly driven by increased use of NOACs and reduced use of VKA±AP or AP alone. TRIAL REGISTRATION NUMBER NCT01090362; Pre-results.","author":[{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Accetta","given":"Gabriele","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ambrosio","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atar","given":"Dan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bassand","given":"Jean-Pierre","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Berge","given":"Eivind","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cools","given":"Frank","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fitzmaurice","given":"David A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goldhaber","given":"Samuel Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goto","given":"Shinya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haas","given":"Sylvia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kayani","given":"Gloria","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Koretsune","given":"Yukihiro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mantovani","given":"Lorenzo G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Misselwitz","given":"Frank","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oh","given":"Seil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turpie","given":"Alexander G G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verheugt","given":"Freek W A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kakkar","given":"Ajay K","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"GARFIELD-AF Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","2"]]},"page":"307-314","title":"Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation","type":"article-journal","volume":"103"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.1093/europace/eux301","ISSN":"1532-2092","PMID":"29016832","abstract":"Aims Contemporary data regarding atrial fibrillation (AF) management and current use of oral anticoagulants (OACs) for stroke prevention are needed. Methods and results The EURObservational Research Programme on AF (EORP-AF) Long-Term General Registry analysed consecutive AF patients presenting to cardiologists in 250 centres from 27 European countries. From 2013 to 2016, 11 096 patients were enrolled (40.7% female; mean age 69 ± 11 years). At discharge, OACs were used in 9379 patients (84.9%), with non-vitamin K antagonists (NOACs) accounting for 40.9% of OACs. Antiplatelet therapy alone was used by 20% of patients, while no antithrombotic treatment was prescribed in 6.4%. On multivariable analysis, age, hypertension, previous ischaemic stroke, symptomatic AF and planned cardioversion or ablation were independent predictors of OAC use, whereas lone AF, previous haemorrhagic events, chronic kidney disease and admission for acute coronary syndrome (ACS) or non-cardiovascular causes independently predicted OAC non-use. Regarding the OAC type, coronary artery disease, history of heart failure, or valvular heart disease, planned cardioversion and non-AF reasons for admission independently predicted the use of vitamin K antagonists (VKAs). Wide variability among the European regions was observed in the use of NOACs, independently from other clinical factors. Conclusion The EORP-AF Long-Term General Registry provides a full picture of contemporary use of OAC in European AF patients. The overall rate of OACs use was generally high (84.9%), and a series of factors were associated with the prescription of OAC. A significant geographical heterogeneity in prescription of NOACs vs. VKAs was evident.","author":[{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"Cécile","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fauchier","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Marin","given":"Francisco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nabauer","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Potpara","given":"Tatjana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dan","given":"Gheorghe-Andrei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalarus","given":"Zbigniew","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Diemberger","given":"Igor","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tavazzi","given":"Luigi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"Aldo P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y. H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"EORP-AF Long-Term General Registry Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","id":"ITEM-4","issue":"November","issued":{"date-parts":[["2017"]]},"page":"1-11","title":"Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) Long-Term General Registry.","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"^3–6","plainTextFormattedCitation":"3–6","previouslyFormattedCitation":"^3–6"},"properties":{"noteIndex":0},"schema":""}3–6.There has been much interest in expanding the understanding of AF pathophysiology, epidemiology and natural history, leading to an increasing number of papers on AF being published [Figure 1]. The deluge of data available has informed how several new issues are managed and have led to a change in clinical practice regarding patients with AF, both regarding the evaluation and reduction of thromboembolic risk as well as the general management of such patients. There is also an increasing focus on how the risk of cardiovascular and all-cause death is becoming an even more relevant issue in clinical history and clinical management of these patientsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCULATIONAHA.112.000491","ISSN":"1524-4539 (Electronic)","PMID":"24016454","abstract":"BACKGROUND: Atrial fibrillation is associated with increased mortality, but the specific causes of death and their predictors have not been described among patients on effective anticoagulant therapy. METHODS AND RESULTS: The Randomized Evaluation of Long-Term Anticoagulant Therapy (RE-LY) trial randomized 18 113 patients (age, 71.5 +/- 9 years; male, 64%; CHADS2 score, 2.1 +/- 1) to receive dabigatran or warfarin. Median follow-up was 2 years, and complete follow-up was achieved in 99.9% of patients. All deaths were categorized by the investigators using prespecified definitions followed by central adjudication. Overall, 1371 deaths occurred (annual mortality rate, 3.84%; 95% confidence interval [CI], 3.64-4.05). Cardiac deaths (sudden cardiac death and progressive heart failure) accounted for 37.4% of all deaths, whereas stroke- and hemorrhage-related deaths represented 9.8% of the total mortality. An examination of the causes of death according to dabigatran or warfarin showed that dabigatran significantly reduced vascular (embolism and hemorrhage-related) mortality (relative risk, 0.63; 95% CI, 0.45-0.88; P=0.007), whereas other causes of death were similar between treatments, including cardiac mortality (relative risk, 0.96; 95% CI, 0.80-1.15; P=0.638). The two strongest independent predictors of cardiac death in this population were heart failure (hazard ratio, 3.02; 95% CI, 2.45-3.73; P<0.0001), and prior myocardial infarction (hazard ratio, 2.05; 95% CI, 1.61-2.62; P<0.0001). CONCLUSIONS: The majority of deaths are not related to stroke in a contemporary anticoagulated atrial fibrillation population. These results emphasize the need to identify interventions beyond effective anticoagulation to further reduce mortality in atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: . Unique identifier: NCT00262600.","author":[{"dropping-particle":"","family":"Marijon","given":"Eloi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Heuzey","given":"Jean-Yves","non-dropping-particle":"Le","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yang","given":"Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pogue","given":"Janice","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brueckmann","given":"Martina","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Eikelboom","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Themeles","given":"Ellison","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ezekowitz","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wallentin","given":"Lars","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yusuf","given":"Salim","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation","id":"ITEM-1","issue":"20","issued":{"date-parts":[["2013","11"]]},"language":"eng","page":"2192-2201","publisher-place":"United States","title":"Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study.","type":"article-journal","volume":"128"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.amjmed.2016.06.045","ISSN":"1555-7162 (Electronic)","PMID":"27476087","abstract":"BACKGROUND: Atrial fibrillation is associated with a higher mortality, but causes of death of atrial fibrillation patients and their specific predictors have been less well defined. We aimed to identify the causes of death among atrial fibrillation patients and secondly, clinical predictors for the different modes of deaths. METHODS: Patients diagnosed with atrial fibrillation in a four-hospital institution between 2000 and 2010 were identified. During a follow-up of 929 +/- 1082 days (median 456, interquartile 10-1584), 1253 deaths were recorded (yearly rate 5.5%). RESULTS: Cardiovascular deaths accounted for 54% and noncardiovascular for 43%. The three main causes of death were heart failure (29%), infection (18%), and cancer (12%). Fatal stroke or fatal bleeding each accounted for 7% of all deaths. On multivariate analysis, the strongest predictors of death were permanent atrial fibrillation, heart failure (whether with decreased or with preserved ejection fraction), previous bleeding, and renal failure, which were independently associated with an increase in the risk of all-cause mortality (35%, 78%, 42%, and 79%, respectively), cardiovascular mortality (43%, 129%, 46%, and 93%, respectively), and noncardiovascular mortality (21%, 45%, 40%, and 50%, respectively). Oral anticoagulant use was independently associated with a lower risk of all-cause mortality (hazard ratio [HR] 0.62; 95% confidence interval [CI], 0.54-0.71; P <.0001), cardiovascular mortality (HR 0.60; 95% CI, 0.49-0.72; P <.0001), and noncardiovascular mortality (HR 0.60; 95% CI, 0.49-0.74; P <.0001). CONCLUSIONS: The majority of deaths were related to a cardiovascular origin, and heart failure was the most common cause of death in atrial fibrillation patients. Despite the high risk of stroke associated with atrial fibrillation, only 7% died from stroke. Optimization of management of any underlying heart disease and associated comorbidities should be a relevant therapeutic target to reduce total mortality in atrial fibrillation patients.","author":[{"dropping-particle":"","family":"Fauchier","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Villejoubert","given":"Olivier","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Clementy","given":"Nicolas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bernard","given":"Anne","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pierre","given":"Bertrand","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Angoulvant","given":"Denis","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ivanes","given":"Fabrice","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Babuty","given":"Dominique","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The American journal of medicine","id":"ITEM-2","issued":{"date-parts":[["2016","7"]]},"language":"ENG","title":"Causes of Death and Influencing Factors in Patients with Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1093/europace/euw112","ISSN":"1532-2092","PMID":"27194538","abstract":"Aims Atrial fibrillation (AF) is commonly associated with a high risk of stroke, thromboembolism, and mortality. The 1-year follow-up of the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot Registry demonstrated a high mortality but good outcomes with European Society of Cardiology guideline-adherent therapy. Whether these 'real-world' observations on patients managed by European cardiologists extend to 2 years remains uncertain. Methods and results In this report from the EORP-AF General Registry Pilot Phase, we provide data on the 2-year follow-up outcomes. Consistent with the 1-year follow-up report, only a small proportion of patients were symptomatic (24.9%), with minor differences between the different AF subtypes. Persistence of oral anticoagulant (OAC) therapy remains high at 2-years, with ～80% of patients treated with OAC. The prescribing rates of non-vitamin K antagonist oral anticoagulants are progressively increasing (13.7% at 2 years). Rate and rhythm control approaches remained consistent across the entire follow-up observation. Overall mortality rates remained high, with 5.0% of patients dead during the 2-year follow-up, mostly due to cardiovascular causes (61.8%). Atrial fibrillation readmissions were frequent, particularly related to arrhythmias and heart failure. On multivariate analyses, any cardiovascular reason for admission rather than AF was significantly associated with increased mortality during the 2-year follow-up. Conclusion In this 2-year follow-up report from EORP-AF, mortality rates with AF remain high from cardiovascular causes, despite the high prevalent use of OAC. Improved management strategies to reduce major adverse outcomes in AF patients are needed.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"Cécile","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Opolski","given":"Grzegorz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"Aldo P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"AF Gen Pilot Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Europace","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2017","5"]]},"page":"722-733","title":"'Real-world' atrial fibrillation management in Europe: observations from the 2-year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase.","type":"article-journal","volume":"19"},"uris":["",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.ejim.2018.05.016","ISSN":"18790828","abstract":"? 2018 European Federation of Internal Medicine Background: In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry. Methods: We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM). Results: After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p =.015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p =.0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p =.021). Conclusions: We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.","author":[{"dropping-particle":"","family":"Proietti","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nieuwlaat","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crijns","given":"H.J.G.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"A.P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"D.A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G.Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European Journal of Internal Medicine","id":"ITEM-4","issued":{"date-parts":[["2018"]]},"title":"Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"^7–10","plainTextFormattedCitation":"7–10","previouslyFormattedCitation":"^7–10"},"properties":{"noteIndex":0},"schema":""}7–10. This change in the risk profile has led to appeals for a new approach to the management of AF patients, involving a more integrated and holistic approachADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/europace/eux318","ISBN":"1532-2092 (Electronic) 1099-5129 (Linking)","ISSN":"15322092","PMID":"29300976","abstract":"There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.","author":[{"dropping-particle":"","family":"Kotecha","given":"Dipak","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Breithardt","given":"Günter","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory 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new approaches to atrial fibrillation management: The 6th AFNET/EHRA Consensus Conference","type":"article-journal","volume":"20"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/S0140-6736(17)31072-3","ISSN":"1474-547X","PMID":"28460828","abstract":"Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2-3% of the population in Europe and the USA and requiring 1-3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a challenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke. Once diagnosed, atrial fibrillation requires chronic, multidimensional management in five domains (acute management, treatment of underlying and concomitant cardiovascular conditions, stroke prevention therapy, rate control, and rhythm control). The consistent provision of these treatment options to all patients with atrial fibrillation is difficult, despite recent improvements in organisation of care, knowledge about atrial fibrillation, and treatment options. Integrated care models that provide patient-centred care in, or close to, the patient's community while maintaining access to all specialist treatment options, emerge as the best approach to achieve consistent delivery of these chronic treatments to all patients with atrial fibrillation. Ongoing research efforts will establish when to initiate oral anticoagulation in patients with device-detected atrial high-rate episodes, quantify the prognostic effect of early and comprehensive rhythm control therapy, including atrial fibrillation ablation, and delineate optimum methods to reduce bleeding complications in patients treated with anticoagulation. Additionally, research efforts are needed to define different types of atrial fibrillation on the basis of the main causes of atrial fibrillation to pave the way for the clinical development of stratified atrial fibrillation therapy.","author":[{"dropping-particle":"","family":"Kirchhof","given":"Paulus","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet (London, England)","id":"ITEM-2","issue":"10105","issued":{"date-parts":[["2017","10"]]},"page":"1873-1887","title":"The future of atrial fibrillation management: integrated care and stratified therapy.","type":"article-journal","volume":"390"},"uris":["",""]}],"mendeley":{"formattedCitation":"^11,12","plainTextFormattedCitation":"11,12","previouslyFormattedCitation":"^11,12"},"properties":{"noteIndex":0},"schema":""}11,12.In the last two years alone, there have been several new guidelines or guideline updates that have been published, introducing new recommendations and significantly revising the previously published onesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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This narrative review aims to provide a comparison of these contemporary international guidelines or updates, with particular attention to the evaluation of thromboembolic and bleeding risks and management of OAC therapy. Overview and General Features of Contemporary International GuidelinesWe provide an overview of the new guidelines published in the last two yearsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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General characteristics of these new guidelines are reported in Table 1. In 2016 the Canadian Cardiovascular Society (CCS) published an updateADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. 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Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁵","plainTextFormattedCitation":"15","previouslyFormattedCitation":"¹⁵"},"properties":{"noteIndex":0},"schema":""}15. Finally, three entirely new guidelines in 2018 from National Heart Foundation of Australia (NHFA)/Cardiac Society of Australia and New Zealand (CSANZ)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁶","plainTextFormattedCitation":"16","previouslyFormattedCitation":"¹⁶"},"properties":{"noteIndex":0},"schema":""}16, from the American College of Chest Physicians (ACCP)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17 and Korean Heart Rhythm Society (KHRS)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁹","plainTextFormattedCitation":"19","previouslyFormattedCitation":"¹⁹"},"properties":{"noteIndex":0},"schema":""}19 with a second focused updated from the CCS guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim 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We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-5","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^{13,14,16–18}","plainTextFormattedCitation":"13,14,16–18","previouslyFormattedCitation":"^{13,14,16–18}"},"properties":{"noteIndex":0},"schema":""}13,14,16–18. Conversely, the APHRS and KHRS guidelines were substantially based on expert consensus reviewADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^15,19","plainTextFormattedCitation":"15,19","previouslyFormattedCitation":"^15,19"},"properties":{"noteIndex":0},"schema":""}15,19. The ‘Grading of Recommendations, Assessment, Development and Evaluations’ (GRADE) methodology was used to evaluate the quality of scientific evidence in four of the seven guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. 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This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"^13,16–18","plainTextFormattedCitation":"13,16–18","previouslyFormattedCitation":"^13,16–18"},"properties":{"noteIndex":0},"schema":""}13,16–18. Heterogeneity was evident in the grading of the strength of the recommendations and quality of evidence, with APHRS guidelines not explicitly grading their recommendationsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁵","plainTextFormattedCitation":"15","previouslyFormattedCitation":"¹⁵"},"properties":{"noteIndex":0},"schema":""}15 and with KHRS ones only grading a limited number of recommendationsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁹","plainTextFormattedCitation":"19","previouslyFormattedCitation":"¹⁹"},"properties":{"noteIndex":0},"schema":""}19. Concerning conflict of interests, only the ESC, NHFA/CSANZ and ACCP guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"^14,16,17","plainTextFormattedCitation":"14,16,17","previouslyFormattedCitation":"^14,16,17"},"properties":{"noteIndex":0},"schema":""}14,16,17 provided detailed disclosure of direct, indirect and potential conflict of interests, with the latter, ACCP, prohibiting voting on those issues for which an author reported a potential conflict of interest.While we found a considerable variability regarding the classification of clinical types of AF, in particular related to the use of new onset/first detected AF and long-standing persistent AF, there was a substantial agreement across the various guidelines regarding the definition of non-valvular AF which is generally considered as the absence of mitral stenosis, even though some guidelines specifically stated the differential rheumatic or non-rheumatic origin and the degree of disease, and of mechanical heart valve. Notwithstanding, two guidelines did not assess the definitionADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei 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and OAC PrescriptionWhen evaluating thromboembolic risk (Table 2), most guidelines recommended the use of CHA2DS2-VASc scoreADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-3","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern 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This modification of the CHA2DS2-VASc score in the NFHA/CSANZ guidelines was justified by differential cut-offs for male and female AF patients or recommendations to exclude the sex category in the evaluation by other guidelines(Table 2)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-4","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^14,15,17,19","plainTextFormattedCitation":"14,15,17,19","previouslyFormattedCitation":"^14,15,17,19"},"properties":{"noteIndex":0},"schema":""}14,15,17,19. The 5 guidelines using CHA2DS2-VASc score, recommend prescribing OAC therapy in all patients with at least 1 non-sex related risk factorsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern 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4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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While in the latter (CHA2DS2-VASc score ≥2) OAC is recommended, with a strong recommendation based on a high level of evidence, the level of evidence regarding the recommendation for patients with CHA2DS2-VASc score of 1 is lower, given that fewer such patients were included in the randomised trials. In the 2018 ACCP guidelines, the overall recommendation of prescribing all patients with at least 1 stroke risk factor is a stroke recommendation based on moderate quality of evidenceADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. Of the most recent guidelines, ACCP and KHRS also underline how, on the basis of some recent evidence, stroke risk assessment needs to be considered a dynamic process and should be reassessed at the regular follow-up visitsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^17,19","plainTextFormattedCitation":"17,19","previouslyFormattedCitation":"^17,19"},"properties":{"noteIndex":0},"schema":""}17,19.The Canadian guidelines differ from other guidelines since the evaluation of thromboembolic risk is based on the CHADS-65 algorithm, also known as the CCS algorithmADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,18","plainTextFormattedCitation":"13,18","previouslyFormattedCitation":"^13,18"},"properties":{"noteIndex":0},"schema":""}13,18. This algorithm is a three-step evaluation scheme, that recommends evaluating the patient’s age first, with all patients aged ≥65 years old recommended for OAC, followed by assessment of the presence of stroke risk factors according to the CHADS2 risk scoreADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0098-7484","PMID":"11401607","abstract":"CONTEXT: Patients who have atrial fibrillation (AF) have an increased risk of stroke, but their absolute rate of stroke depends on age and comorbid conditions.\n\nOBJECTIVE: To assess the predictive value of classification schemes that estimate stroke risk in patients with AF.\n\nDESIGN, SETTING, AND PATIENTS: Two existing classification schemes were combined into a new stroke-risk scheme, the CHADS( 2) index, and all 3 classification schemes were validated. The CHADS( 2) was formed by assigning 1 point each for the presence of congestive heart failure, hypertension, age 75 years or older, and diabetes mellitus and by assigning 2 points for history of stroke or transient ischemic attack. Data from peer review organizations representing 7 states were used to assemble a National Registry of AF (NRAF) consisting of 1733 Medicare beneficiaries aged 65 to 95 years who had nonrheumatic AF and were not prescribed warfarin at hospital discharge.\n\nMAIN OUTCOME MEASURE: Hospitalization for ischemic stroke, determined by Medicare claims data.\n\nRESULTS: During 2121 patient-years of follow-up, 94 patients were readmitted to the hospital for ischemic stroke (stroke rate, 4.4 per 100 patient-years). As indicated by a c statistic greater than 0.5, the 2 existing classification schemes predicted stroke better than chance: c of 0.68 (95% confidence interval [CI], 0.65-0.71) for the scheme developed by the Atrial Fibrillation Investigators (AFI) and c of 0.74 (95% CI, 0.71-0.76) for the Stroke Prevention in Atrial Fibrillation (SPAF) III scheme. However, with a c statistic of 0.82 (95% CI, 0.80-0.84), the CHADS( 2) index was the most accurate predictor of stroke. The stroke rate per 100 patient-years without antithrombotic therapy increased by a factor of 1.5 (95% CI, 1.3-1.7) for each 1-point increase in the CHADS( 2) score: 1.9 (95% CI, 1.2-3.0) for a score of 0; 2.8 (95% CI, 2.0-3.8) for 1; 4.0 (95% CI, 3.1-5.1) for 2; 5.9 (95% CI, 4.6-7.3) for 3; 8.5 (95% CI, 6.3-11.1) for 4; 12.5 (95% CI, 8.2-17.5) for 5; and 18.2 (95% CI, 10.5-27.4) for 6.\n\nCONCLUSION: The 2 existing classification schemes and especially a new stroke risk index, CHADS( 2), can quantify risk of stroke for patients who have AF and may aid in selection of antithrombotic therapy.","author":[{"dropping-particle":"","family":"Gage","given":"B F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Waterman","given":"A D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shannon","given":"W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boechler","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rich","given":"M W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Radford","given":"M J","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JAMA","id":"ITEM-1","issue":"22","issued":{"date-parts":[["2001","6","13"]]},"page":"2864-70","title":"Validation of clinical classification schemes for predicting stroke: results from the National Registry of Atrial Fibrillation.","type":"article-journal","volume":"285"},"uris":[""]}],"mendeley":{"formattedCitation":"²³","plainTextFormattedCitation":"23","previouslyFormattedCitation":"²³"},"properties":{"noteIndex":0},"schema":""}23, where patients with at least 1 risk factor should receive OAC, and lastly evaluating the presence of coronary artery disease (CAD) or other arterial vascular disease, recommending the prescription of aspirin in those patients aged <65 years with isolated CADADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,18","plainTextFormattedCitation":"13,18","previouslyFormattedCitation":"^13,18"},"properties":{"noteIndex":0},"schema":""}13,18. The Canadian guidelines remain the only one still recommending the use of aspirin in AF patients aged <65 years with isolated CAD and no other CHADS2 stroke risk factors. Conversely, all other guidelines firmly recommend against the use of antiplatelet therapy for thromboembolic risk treatmentADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-3","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-5","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-5","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^14–17,19","plainTextFormattedCitation":"14–17,19","previouslyFormattedCitation":"^14–17,19"},"properties":{"noteIndex":0},"schema":""}14–17,19.When OAC is indicated, all guidelines agree about the preferential use of NOACs over VKA therapyADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-4","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^14,15,17,19","plainTextFormattedCitation":"14,15,17,19","previouslyFormattedCitation":"^14,15,17,19"},"properties":{"noteIndex":0},"schema":""}14,15,17,19.Evaluation of Bleeding RiskAfter the evaluation of thromboembolic risk, all guidelines point the attention to the bleeding risk evaluation (Table 3). Most strongly recommend the use of the HAS-BLED risk score to evaluate bleeding risk, with a moderate to a high quality of evidenceADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-5","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-5","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^{13,15,17–19}","plainTextFormattedCitation":"13,15,17–19","previouslyFormattedCitation":"^{13,15,17–19}"},"properties":{"noteIndex":0},"schema":""}13,15,17–19. 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atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Nonetheless, the ESC guidelines underline how, irrespectively of the score used, the main aim is to be to identify those patients with modifiable or potentially modifiable bleeding risk factorsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic 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This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Instead, efforts should be used to identify all the modifiable bleeding risk factors and address them where possible, discussing these with the patient, and providing more frequent and regular checks and follow-up visitsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Similarly to thromboembolic risk, ACCP and KHRS guidelines recommend a reassessment of bleeding risk on a regular basis in light of its dynamic impact on bleeding riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^17,19","plainTextFormattedCitation":"17,19","previouslyFormattedCitation":"^17,19"},"properties":{"noteIndex":0},"schema":""}17,19.Utility of Left Atrial Appendage ClosureAll the guidelines agreed that left atrial appendage (LAA) closure should not be routinely used for the management of thromboembolic risk in patients with AF (Table S1). While the Canadian guidelines suggest, with a low quality of evidence, that LAA closure should be considered only as part of the ablation procedure, even though clearly contraindicated in patients at high risk of strokeADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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only be considered in those patients with absolute contra-indications to OAC useADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-3","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-5","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^14–17,19","plainTextFormattedCitation":"14–17,19","previouslyFormattedCitation":"^14–17,19"},"properties":{"noteIndex":0},"schema":""}14–17,19. Overall, the guidelines judged the quality of evidence regarding LAA closure to be low.Management of OAC and Antiplatelet TherapySeveral epidemiological studies have shown that AF is often associated with acute coronary syndrome (ACS) and myocardial infarction (MI)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1001/jamainternmed.2013.11912","ISSN":"2168-6114","PMID":"24190540","abstract":"IMPORTANCE: Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated.\n\nOBJECTIVE: To examine the risk of incident MI associated with AF.\n\nDESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009.\n\nMAIN OUTCOMES AND MEASURES: Expert-adjudicated total MI events (fatal and nonfatal).\n\nRESULTS: Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52-2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26-2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure-lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41-3.31]) than in men (HR, 1.39 [95% CI, 0.91-2.10]) and in blacks (HR, 2.53 [95% CI, 1.67-3.86]) than in whites (HR, 1.26 [95% CI, 0.83-1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (≥75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16-3.35] and HR, 1.60 [95% CI, 1.11-2.30], respectively); for interaction, P = .44.\n\nCONCLUSIONS AND RELEVANCE: AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.","author":[{"dropping-particle":"","family":"Soliman","given":"Elsayed Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Safford","given":"Monika M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Muntner","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Khodneva","given":"Yulia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dawood","given":"Farah Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zakai","given":"Neil A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thacker","given":"Evan L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Judd","given":"Suzanne","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howard","given":"Virginia J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howard","given":"George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Herrington","given":"David M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cushman","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JAMA internal medicine","id":"ITEM-1","issue":"1","issued":{"date-parts":[["2014","1"]]},"page":"107-14","title":"Atrial fibrillation and the risk of myocardial infarction.","type":"article-journal","volume":"174"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1161/CIRCULATIONAHA.114.014145","ISSN":"1524-4539","PMID":"25918127","abstract":"BACKGROUND: It has recently been reported that atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association is currently unknown. Further study of the relationship of AF with the type of MI (ST-segment-elevation MI [STEMI] versus non-ST-segment-elevation MI [NSTEMI]) might shed light on the potential mechanisms.\n\nMETHODS AND RESULTS: We examined the association between AF and incident MI in 14?462 participants (mean age, 54 years; 56% women; 26% blacks) from the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary heart disease at baseline (1987-1989) with follow-up through December 31, 2010. AF cases were identified from study visit ECGs and by review of hospital discharge records. Incident MI and its types were ascertained by an independent adjudication committee. Over a median follow-up of 21.6 years, 1374 MI events occurred (829 NSTEMIs, 249 STEMIs, 296 unclassifiable MIs). In a multivariable-adjusted model, AF (n=1545) as a time-varying variable was associated with a 63% increased risk of MI (hazard ratio,1.63; 95% confidence interval, 1.32-2.02). However, AF was associated with NSTEMI (hazard ratio, 1.80; 95% confidence interval, 1.39-2.31) but not STEMI (hazard ratio, 0.49; 95% confidence interval, 0.18-1.34; P for hazard ratio comparison=0.004). Combining the unclassifiable MI group with either STEMI or NSTEMI did not change this conclusion. The association between AF and MI, total and NSTEMI, was stronger in women than in men (P for interaction <0.01 for both).\n\nCONCLUSIONS: AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI.","author":[{"dropping-particle":"","family":"Soliman","given":"Elsayed Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lopez","given":"Faye","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"O'Neal","given":"Wesley T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"Lin Y","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bengtson","given":"Lindsay","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Zhu-Ming","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Loehr","given":"Laura","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cushman","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Alonso","given":"Alvaro","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation","id":"ITEM-2","issue":"21","issued":{"date-parts":[["2015","5"]]},"page":"1843-50","title":"Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study.","type":"article-journal","volume":"131"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1160/TH15-07-0612","ISSN":"03406245","abstract":"? Schattauer 2016. Atrial fibrillation (AF) patients are at high risk for thrombotic and vascular events related to their cardiac arrhythmia and underlying systemic atherosclerosis. Ankle-Brachial Index (ABI) is a non-invasive tool in evaluating systemic atherosclerosis, useful in predicting cardiovascular events in general population; no data are available in AF patients. ARAPACIS is a prospective multicentre observational study performed by the Italian Society of Internal Medicine, analysing association between low ABI (≤ 0.90) and vascular events in NVAF out- or in-patients, enrolled in 136 Italian centres. A total of 2,027 non-valvular AF (NVAF) patients aged > 18 years from both sexes followed for a median time of 34.7 (interquartile range: 22.0–36.0) months, yielding a total of 4,614 patient-years of observation. Mean age was 73 ± 10 years old with 55% male patients. A total of 176 patients (8.7%) experienced a vascular event, with a cumulative incidence of 3.81%/patient-year. ABI≤ 0.90 was more prevalent in patients with a vascular event compared with patients free of vascular events (32.2 vs 20.2%, p < 0.05). On Cox proportional hazard analysis, ABI≤ 0.90 was an independent predictor of vascular events (hazard ratio (HR): 1.394, 95% confidence interval (CI): 1.042–1.866; p=0.02), vascular death (HR: 2.047, 95% CI: 1.255–3.338; p=0.004) and MI (HR: 2.709, 95% CI: 1.485–5.083; p=0.001). This latter association was also confirmed after excluding patients with previous MI (HR: 2.901, 95% CI: 1.408–5.990, p=0.004). No association was observed between low ABI and stroke/transient ischaemic attack (p=0.91). In conclusion, low ABI is useful to predict MI and vascular death in NVAF patients and may independently facilitate cardiovascular risk assessment in NVAF patients.","author":[{"dropping-particle":"","family":"Violi","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davì","given":"G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Proietti","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pastori","given":"D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hiatt","given":"W.R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Corazza","given":"G.R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Perticone","given":"F.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pignatelli","given":"P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farcomeni","given":"A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vestri","given":"A.R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G.Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Basili","given":"S.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and Haemostasis","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2016"]]},"title":"Ankle-Brachial Index and cardiovascular events in atrial fibrillation: The ARAPACIS study","type":"article-journal","volume":"115"},"uris":[""]}],"mendeley":{"formattedCitation":"^24–26","plainTextFormattedCitation":"24–26","previouslyFormattedCitation":"^24–26"},"properties":{"noteIndex":0},"schema":""}24–26. One of the main concerns in patients presenting with AF and ACS/MI is the management of dual or triple antithrombotic therapy (OAC plus single or dual antiplatelet therapy) with respect to balancing atherothrombotic, thromboembolic and bleeding risk. In the antithrombotic decision-making process, a primary distinction has to be drawn between patients presenting with ACS and those undergoing elective percutaneous coronary intervention (PCI) with stent. For patients presenting with ACS and undergoing urgent PCI with stent, almost all the guidelines recommend treatment with triple antithrombotic, with the duration varying from 1-6 months, with shortening of triple therapy based on bleeding riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-6","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13–18","plainTextFormattedCitation":"13–18","previouslyFormattedCitation":"^13–18"},"properties":{"noteIndex":0},"schema":""}13–18. For example, the recent ACCP guidelines specifically recommend using triple therapy for 6 months in patients with low bleeding risk, shortening duration to1 to 3 months in patients with high bleeding risk, while recommending avoiding it completely in those patients with very high bleeding riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. Following the period of triple therapy, duration of dual antithrombotic therapy should not be continued longer than 12 months after the PCI. In addition, all guidelines indicate a preference for clopidogrel over aspirin as the choice of antiplatelet drug. Recommendations regarding patients with ACS and undergoing urgent PCI (irrespective of stent placement) are generally on the basis of low or moderate quality of evidenceADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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placement, most of the guidelines (ESC, APHRS, NHFA/CSANZ, KHRS) recommend a short duration of triple antithrombotic therapy very short, up to a maximum of 1 monthADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei 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According to ACCP guidelines in patients with low bleeding risk, the duration of triple therapy is recommended for 1 month, followed by 12 months of clopidogrel plus OAC; conversely in patients with high risk of bleeding, while the duration of triple therapy is kept to 1 month, the guidelines recommend shortening the dual antithrombotic therapy up to 6 months after the procedure. Finally, in those patients with very high bleeding risk use of triple therapy is not recommended, and the duration of dual antithrombotic therapy should be kept up to 6 monthsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. The Canadian guidelines recommend a bit different approach. In the 2016 update they did not recommend at all use of triple therapy for elective PCI, suggesting only dual antithrombotic therapy with clopidogrel. In the 2018 version, they changed the recommendations by introducing the use of triple antithrombotic therapy in elective PCI in consideration of the high risk of thrombotic coronary events associated with some clinical variables (i.e. diabetes mellitus, smoking, chronic kidney disease, previous coronary events, etc.) and of type of stentADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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Those patients with high risk features are recommended to be treated for up to 6 months with triple antithrombotic therapy, followed by dual therapy for up to 12 months post stent. However, in patients without high risk features, triple therapy is not recommendedADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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It is important to underline that all the recommendations regarding the use of triple therapy in AF patients receiving elective PCI are weak and based on moderate to low quality of evidence.Regarding OAC prescription, the CCS, APHRS, KHRS guidelines recommend NOACs over VKAs in ACS patients, although there is less robust evidenceADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. 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This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. 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The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-4","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,15,18,19","plainTextFormattedCitation":"13,15,18,19","previouslyFormattedCitation":"^13,15,18,19"},"properties":{"noteIndex":0},"schema":""}13,15,18,19. While the NHFA/CSANZ guidelines do not provide any particular recommendation in this regardADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁶","plainTextFormattedCitation":"16","previouslyFormattedCitation":"¹⁶"},"properties":{"noteIndex":0},"schema":""}16. The ESC guidelines recommend the use of the lowest approved dosage of NOACs when co-administered with antiplatelet drugsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁴","plainTextFormattedCitation":"14","previouslyFormattedCitation":"¹⁴"},"properties":{"noteIndex":0},"schema":""}14, while the ACCP guidelines recommend NOACs as equal to VKAs, but with a weaker recommendation based on a lower quality of evidenceADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17.Management of Oral Anticoagulant in Cardioversion and Ablation ProceduresWith regard to ablation procedures, all guidelines agree on three main pillars: i) uninterrupted OAC is recommended for patients undergoing ablation procedure; ii) after procedure, OAC therapy is recommended as compulsory for at least 8 weeks in all the patients; iii) long-term OAC prescription beyond the first 8 weeks, should be based on risk profile and proposed only to patients with high risk of strokeADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Luis","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Taylor","given":"Clare J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gelder","given":"Isabelle C.","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Voors","given":"Adriaan A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Windecker","given":"Stephan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zamorano","given":"Jose Luis","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zeppenfeld","given":"Katja","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European Heart Journal","id":"ITEM-1","issue":"38","issued":{"date-parts":[["2016","10"]]},"page":"2893-2962","publisher":"Oxford University Press","title":"2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Regarding the type of OAC to be prescribed for pre- and peri-procedural uninterrupted treatment, the ESC, APHRS and CCS 2018 guidelines all recommend NOACs and VKAs as equal alternativesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-3","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^14,15,18","plainTextFormattedCitation":"14,15,18","previouslyFormattedCitation":"^14,15,18"},"properties":{"noteIndex":0},"schema":""}14,15,18. As a notable exception, the recent ACCP guidelines only recommend dabigatran or rivaroxaban among the NOACsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17.With respect to OAC in patients undergoing a cardioversion procedure, all the guidelines agreed on some basic principles: i) in patients with at least 48 hours of proved AF, anticoagulation should be provided for at least 3 weeks to exclude the presence of any left atrial thrombus; ii) as an alternative to OAC, use of a trans-esophageal echocardiogram to exclude the presence of any left atrial thrombus; iii) OAC should be continued for at least 4 weeks after procedure, irrespective of the success of cardioversion procedureADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Most of the guidelines agree that long-term OAC, irrespective of the success of cardioversion procedure, should be considered on the basis of stroke risk factorsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-3","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Several guidelines also explicitly recommended to provide 3 to 4 weeks OAC treatment if a thrombus is identified on the trans-esophageal echocardiogramADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-4","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^14,15,17,19","plainTextFormattedCitation":"14,15,17,19","previouslyFormattedCitation":"^14,15,17,19"},"properties":{"noteIndex":0},"schema":""}14,15,17,19. ACCP 2018 and CCS 2018 guidelines provided recommendations regarding specific situations. ACCP guidelines provide an indication about not commencing OAC for patients with <48 hours AF and hemodynamic instability, rather initiate parenteral anticoagulation as soon as it is possibleADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. In the CCS 2018 guidelines, is indicated that in patients with very short (<12 hours) or short (12-48 hours) AF duration, OAC can be avoided if there is no substantial risk of strokeADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁸","plainTextFormattedCitation":"18","previouslyFormattedCitation":"¹⁸"},"properties":{"noteIndex":0},"schema":""}18.Management of OAC in Specific PopulationsOne of the most debated issues in the management of OAC therapy is the prescription in elderly (very elderly) and frail patients (Table S2). Among the guidelines examined, the CCS (having discussed the issue in the previous 2010 and 2012 versions, but they do not make any recommendations in 2016 and 2018), and APHRS guidelines did not consider this issueADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,15,18","plainTextFormattedCitation":"13,15,18","previouslyFormattedCitation":"^13,15,18"},"properties":{"noteIndex":0},"schema":""}13,15,18. The ESC guidelines state that the available evidence supports the use of OAC in elderly and frail subjects, due to the high benefit-risk ratioADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁴","plainTextFormattedCitation":"14","previouslyFormattedCitation":"¹⁴"},"properties":{"noteIndex":0},"schema":""}14. The NHFA/CSANZ guidelines highlight the beneficial effect of OAC in elderly patients observed in observational registries, with a preference for the use of NOACs, due to the high prevalence of polypharmacy, although caution is recommended with dose-adjustment related to renal functionADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁶","plainTextFormattedCitation":"16","previouslyFormattedCitation":"¹⁶"},"properties":{"noteIndex":0},"schema":""}16. The ACCP guidelines recommend a specific individual risk assessment prior to OAC prescription while reaffirming that the benefit of OAC prescription generally outweigh the risk of harm from serious bleeding, whilst highlighting a contraindication to OAC prescription is posed for patients with dementia and no caregiver (to administer OAC)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17. Similar recommendations are included in the KHRS guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁹","plainTextFormattedCitation":"19","previouslyFormattedCitation":"¹⁹"},"properties":{"noteIndex":0},"schema":""}19. Guidelines including specific recommendations about elderly patients did not rate these recommendations.Another important population is are patients with chronic kidney disease. Impaired renal function is an independent risk factor for stroke, major bleeding and major adverse outcomes in patients with AFADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.jacc.2016.06.057","ISSN":"15583597","abstract":"? 2016 American College of Cardiology Foundation A bidirectional relationship exists between atrial fibrillation (AF) and chronic renal disease. Patients with AF have a higher incidence of renal dysfunction, and the latter predisposes to incident AF. The coexistence of both conditions results in a higher risk for thromboembolic-related adverse events but a paradoxical increased hemorrhagic risk. Oral anticoagulants (both vitamin K antagonists [VKAs] and non-VKA oral anticoagulants [NOACs] ) have been demonstrated to be effective in?mild to moderate renal dysfunction. Patients with severe renal impairment were excluded from the non-VKA oral anticoagulant trials, so limited data are available. In end-stage renal failure, the net clinical benefit of VKAs in dialysis-dependent patients remains uncertain, although some evidence suggests that such patients may do well with high-quality anticoagulation control. Risk stratification and careful follow-up of such patients are necessary to ensure a net clinical benefit from thromboprophylaxis.","author":[{"dropping-particle":"","family":"Lau","given":"Y.C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Proietti","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Guiducci","given":"E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Blann","given":"A.D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G.Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American College of Cardiology","id":"ITEM-1","issue":"13","issued":{"date-parts":[["2016"]]},"title":"Atrial Fibrillation and Thromboembolism in?Patients With Chronic Kidney Disease","type":"article-journal","volume":"68"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁷","plainTextFormattedCitation":"27","previouslyFormattedCitation":"²⁷"},"properties":{"noteIndex":0},"schema":""}27, thus these patients need careful management in order to maximize stroke prevention and reduce bleeding risk, and the guidelines differ in their recommendations for managing such patients (Table S2) and the lower limit for which OAC use is no longer recommended. Both Canadian guidelines suggest that OAC should not be routinely prescribed for patients with glomerular filtration rate (GFR) <15 mL/min, but that use of OAC may be appropriate in some patients in whom there is a stronger preference in avoiding stroke despite the uncertain benefit and the associated bleeding riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,18","plainTextFormattedCitation":"13,18","previouslyFormattedCitation":"^13,18"},"properties":{"noteIndex":0},"schema":""}13,18. Lack of data, with limited evidence about efficacy and safety of OAC in patients with GFR <30 mL/min and <15 mL/min are claimed by APHRSADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei 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{"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim 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management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁴","plainTextFormattedCitation":"14","previouslyFormattedCitation":"¹⁴"},"properties":{"noteIndex":0},"schema":""}14. Although the APHRS, ACCP and KHRS guidelines recognise the limited evidence, they suggest that use of VKAs with well-managed quality of anticoagulation therapy could be consideredADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-2","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-3","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^15,17,19","plainTextFormattedCitation":"15,17,19","previouslyFormattedCitation":"^15,17,19"},"properties":{"noteIndex":0},"schema":""}15,17,19.In patients with moderate to severe CKD (GFR 15-30 mL/min), treatment strategies differ across guidelines. Both Canadian guidelines recommend OAC prescription on the basis of stroke risk, with warfarin the preferred agentADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,18","plainTextFormattedCitation":"13,18","previouslyFormattedCitation":"^13,18"},"properties":{"noteIndex":0},"schema":""}13,18, while the APHRS, ACCP and KHRS guidelines suggest the use of OAC with caution, with the recommendation to reduce NOACs dosages.ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-2","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-3","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^15,17,19","plainTextFormattedCitation":"15,17,19","previouslyFormattedCitation":"^15,17,19"},"properties":{"noteIndex":0},"schema":""}15,17,19 The ESC guidelines also recommend reducing the NOAC dosage, although the reduction is suggested for patients with GRF 25-50 mL/min. The adjustment of NOACs dosage is also suggested by the other guidelines for patients with GFR >30 and up to 50 or 60 mL/min, according to guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-4","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-5","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-5","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^{13,15,17–19}","plainTextFormattedCitation":"13,15,17–19","previouslyFormattedCitation":"^{13,15,17–19}"},"properties":{"noteIndex":0},"schema":""}13,15,17–19. It is relevant to note that the majority of the recommendations are weak and based on a low quality of evidence, underlining the need for more solid evidence.One emergent issue is that related to the treatment of patients with cardiac implantable electronic devices, without clinical AF, that are found to have atrial high rate episodes (AHREs). While some guidelines did not consider this issueADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^15,19","plainTextFormattedCitation":"15,19","previouslyFormattedCitation":"^15,19"},"properties":{"noteIndex":0},"schema":""}15,19, others suggest that OAC treatment should be considered in those with prolonged AHREs (>24 hours) and a high risk of stroke (CHA2DS2-VASc ≥2),ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. 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2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern 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are needed to support the use of OAC in patients with AHREs of shorter duration.However, the ESC guidelines do not advocate OAC treatment for patients with AHREsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁴","plainTextFormattedCitation":"14","previouslyFormattedCitation":"¹⁴"},"properties":{"noteIndex":0},"schema":""}14.Use of an Integrated Management in Patients with Atrial FibrillationGiven the increased risk for adverse outcomes other than stroke, such as myocardial infarction, cardiovascular death and all-cause death,ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCULATIONAHA.114.014145","ISSN":"1524-4539","PMID":"25918127","abstract":"BACKGROUND: It has recently been reported that atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association is currently unknown. Further study of the relationship of AF with the type of MI (ST-segment-elevation MI [STEMI] versus non-ST-segment-elevation MI [NSTEMI]) might shed light on the potential mechanisms.\n\nMETHODS AND RESULTS: We examined the association between AF and incident MI in 14?462 participants (mean age, 54 years; 56% women; 26% blacks) from the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary heart disease at baseline (1987-1989) with follow-up through December 31, 2010. AF cases were identified from study visit ECGs and by review of hospital discharge records. Incident MI and its types were ascertained by an independent adjudication committee. Over a median follow-up of 21.6 years, 1374 MI events occurred (829 NSTEMIs, 249 STEMIs, 296 unclassifiable MIs). In a multivariable-adjusted model, AF (n=1545) as a time-varying variable was associated with a 63% increased risk of MI (hazard ratio,1.63; 95% confidence interval, 1.32-2.02). However, AF was associated with NSTEMI (hazard ratio, 1.80; 95% confidence interval, 1.39-2.31) but not STEMI (hazard ratio, 0.49; 95% confidence interval, 0.18-1.34; P for hazard ratio comparison=0.004). Combining the unclassifiable MI group with either STEMI or NSTEMI did not change this conclusion. The association between AF and MI, total and NSTEMI, was stronger in women than in men (P for interaction <0.01 for both).\n\nCONCLUSIONS: AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI.","author":[{"dropping-particle":"","family":"Soliman","given":"Elsayed Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lopez","given":"Faye","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"O'Neal","given":"Wesley T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"Lin Y","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bengtson","given":"Lindsay","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Zhu-Ming","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Loehr","given":"Laura","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cushman","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Alonso","given":"Alvaro","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation","id":"ITEM-1","issue":"21","issued":{"date-parts":[["2015","5"]]},"page":"1843-50","title":"Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study.","type":"article-journal","volume":"131"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/europace/euw112","ISSN":"1532-2092","PMID":"27194538","abstract":"Aims Atrial fibrillation (AF) is commonly associated with a high risk of stroke, thromboembolism, and mortality. The 1-year follow-up of the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot Registry demonstrated a high mortality but good outcomes with European Society of Cardiology guideline-adherent therapy. Whether these 'real-world' observations on patients managed by European cardiologists extend to 2 years remains uncertain. Methods and results In this report from the EORP-AF General Registry Pilot Phase, we provide data on the 2-year follow-up outcomes. Consistent with the 1-year follow-up report, only a small proportion of patients were symptomatic (24.9%), with minor differences between the different AF subtypes. Persistence of oral anticoagulant (OAC) therapy remains high at 2-years, with ～80% of patients treated with OAC. The prescribing rates of non-vitamin K antagonist oral anticoagulants are progressively increasing (13.7% at 2 years). Rate and rhythm control approaches remained consistent across the entire follow-up observation. Overall mortality rates remained high, with 5.0% of patients dead during the 2-year follow-up, mostly due to cardiovascular causes (61.8%). Atrial fibrillation readmissions were frequent, particularly related to arrhythmias and heart failure. On multivariate analyses, any cardiovascular reason for admission rather than AF was significantly associated with increased mortality during the 2-year follow-up. Conclusion In this 2-year follow-up report from EORP-AF, mortality rates with AF remain high from cardiovascular causes, despite the high prevalent use of OAC. Improved management strategies to reduce major adverse outcomes in AF patients are needed.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"Cécile","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Opolski","given":"Grzegorz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"Aldo P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"AF Gen Pilot Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Europace","id":"ITEM-2","issue":"5","issued":{"date-parts":[["2017","5"]]},"page":"722-733","title":"'Real-world' atrial fibrillation management in Europe: observations from the 2-year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase.","type":"article-journal","volume":"19"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.ejim.2018.05.016","ISSN":"18790828","abstract":"? 2018 European Federation of Internal Medicine Background: In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry. Methods: We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM). Results: After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p =.015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p =.0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p =.021). Conclusions: We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.","author":[{"dropping-particle":"","family":"Proietti","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nieuwlaat","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crijns","given":"H.J.G.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"A.P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"D.A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G.Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European Journal of Internal Medicine","id":"ITEM-3","issued":{"date-parts":[["2018"]]},"title":"Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries","type":"article-journal"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1001/jamainternmed.2013.11912","ISSN":"2168-6114","PMID":"24190540","abstract":"IMPORTANCE: Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated.\n\nOBJECTIVE: To examine the risk of incident MI associated with AF.\n\nDESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009.\n\nMAIN OUTCOMES AND MEASURES: Expert-adjudicated total MI events (fatal and nonfatal).\n\nRESULTS: Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52-2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26-2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure-lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41-3.31]) than in men (HR, 1.39 [95% CI, 0.91-2.10]) and in blacks (HR, 2.53 [95% CI, 1.67-3.86]) than in whites (HR, 1.26 [95% CI, 0.83-1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (≥75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16-3.35] and HR, 1.60 [95% CI, 1.11-2.30], respectively); for interaction, P = .44.\n\nCONCLUSIONS AND RELEVANCE: AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.","author":[{"dropping-particle":"","family":"Soliman","given":"Elsayed Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Safford","given":"Monika M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Muntner","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Khodneva","given":"Yulia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dawood","given":"Farah Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zakai","given":"Neil A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thacker","given":"Evan L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Judd","given":"Suzanne","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howard","given":"Virginia J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howard","given":"George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Herrington","given":"David M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cushman","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JAMA internal medicine","id":"ITEM-4","issue":"1","issued":{"date-parts":[["2014","1"]]},"page":"107-14","title":"Atrial fibrillation and the risk of myocardial infarction.","type":"article-journal","volume":"174"},"uris":[""]}],"mendeley":{"formattedCitation":"^9,10,24,25","plainTextFormattedCitation":"9,10,24,25","previouslyFormattedCitation":"^9,10,24,25"},"properties":{"noteIndex":0},"schema":""}9,10,24,25 in AF patients, there is a need for a more integrated and holistic management approach for AF patients, in order to reduce overall cardiovascular riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0140-6736(17)31072-3","ISSN":"1474-547X","PMID":"28460828","abstract":"Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2-3% of the population in Europe and the USA and requiring 1-3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a challenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke. Once diagnosed, atrial fibrillation requires chronic, multidimensional management in five domains (acute management, treatment of underlying and concomitant cardiovascular conditions, stroke prevention therapy, rate control, and rhythm control). The consistent provision of these treatment options to all patients with atrial fibrillation is difficult, despite recent improvements in organisation of care, knowledge about atrial fibrillation, and treatment options. Integrated care models that provide patient-centred care in, or close to, the patient's community while maintaining access to all specialist treatment options, emerge as the best approach to achieve consistent delivery of these chronic treatments to all patients with atrial fibrillation. Ongoing research efforts will establish when to initiate oral anticoagulation in patients with device-detected atrial high-rate episodes, quantify the prognostic effect of early and comprehensive rhythm control therapy, including atrial fibrillation ablation, and delineate optimum methods to reduce bleeding complications in patients treated with anticoagulation. Additionally, research efforts are needed to define different types of atrial fibrillation on the basis of the main causes of atrial fibrillation to pave the way for the clinical development of stratified atrial fibrillation therapy.","author":[{"dropping-particle":"","family":"Kirchhof","given":"Paulus","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet (London, England)","id":"ITEM-1","issue":"10105","issued":{"date-parts":[["2017","10"]]},"page":"1873-1887","title":"The future of atrial fibrillation management: integrated care and stratified therapy.","type":"article-journal","volume":"390"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/europace/eux318","ISBN":"1532-2092 (Electronic) 1099-5129 (Linking)","ISSN":"15322092","PMID":"29300976","abstract":"There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.","author":[{"dropping-particle":"","family":"Kotecha","given":"Dipak","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Breithardt","given":"Günter","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schotten","given":"Ulrich","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ahlsson","given":"Anders","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Arnar","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atar","given":"Dan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Auricchio","given":"Angelo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bax","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Benussi","given":"Stefano","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Blomstrom-Lundqvist","given":"Carina","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Borggrefe","given":"Martin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brandes","given":"Axel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Calkins","given":"Hugh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Casadei","given":"Barbara","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Castellá","given":"Manuel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chua","given":"Winnie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crijns","given":"Harry","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dobrev","given":"Dobromir","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fabritz","given":"Larissa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Feuring","given":"Martin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gerth","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goette","given":"Andreas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Guasch","given":"Eduard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haase","given":"Doreen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hatem","given":"Stephane","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haeusler","given":"Karl 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new approaches to atrial fibrillation management: The 6th AFNET/EHRA Consensus Conference","type":"article-journal","volume":"20"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^11,12","plainTextFormattedCitation":"11,12","previouslyFormattedCitation":"^11,12"},"properties":{"noteIndex":0},"schema":""}11,12. Most guidelines advocate the need for an integrated approach (Table S3), for example, in the 2016 ESC guidelines, in order to improve adherence to treatment, quality of life and long-term outcomesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. 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However, the operationalisation and implementation of integrated care needs to be simple and practical. To address the latter, both the ACCP and KHRS guidelines have suggested that use of the ‘Atrial Fibrillation Better Care’ (ABC)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1038/nrcardio.2017.153","ISSN":"1759-5002","PMID":"28960189","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y. H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Nature Reviews Cardiology","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2017","9","29"]]},"page":"627-628","title":"The ABC pathway: an integrated approach to improve AF management","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁸","plainTextFormattedCitation":"28","previouslyFormattedCitation":"²⁸"},"properties":{"noteIndex":0},"schema":""}28 approach as a practical tool to streamline the integrated management of AF patientsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^17,19","plainTextFormattedCitation":"17,19","previouslyFormattedCitation":"^17,19"},"properties":{"noteIndex":0},"schema":""}17,19.SUMMARY AND DISCUSSIONIn this narrative review, we have discussed the main recommendations regarding OAC management for AF patients from contemporary international guidelines. Most guidelines were compiled with a systematic and well-established approach and rated according to a rigorous evaluation system. There was general agreement in the definition of valvular and non-valvular AF, although some heterogeneity was evident in the temporal classification of AF. Despite not being considered in the OAC decision-making process, the type of AF can influence the risk of major adverse outcomesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw007","ISSN":"1522-9645 (Electronic)","PMID":"26888184","abstract":"AIMS: Thromboembolic risk stratification schemes and clinical guidelines for atrial fibrillation (AF) regard risk as independent of classification into paroxysmal (PAF) and non-paroxysmal atrial fibrillation (NPAF). The aim of the current study was to conduct a systematic review evaluating the impact of AF type on thromboembolism, bleeding, and mortality. METHODS AND RESULTS: PubMed was searched through 27 November 2014 for randomized controlled trials, cohort studies, and case series reporting prospectively collected clinical outcomes stratified by AF type. The incidence of thromboembolism, mortality, and bleeding was extracted. Atrial fibrillation clinical outcome data were extracted from 12 studies containing 99 996 patients. The unadjusted risk ratio (RR) for thromboembolism in NPAF vs. PAF was 1.355 (95% CI: 1.169-1.571, P < 0.001). In the study subset off oral anticoagulation, unadjusted RR was 1.689 (95% CI: 1.151-2.480, P = 0.007). The overall multivariable adjusted hazard ratio (HR) for thromboembolism was 1.384 (95% CI: 1.191-1.608, P < 0.001). The overall unadjusted RR for all-cause mortality was 1.462 (95% CI: 1.255-1.703, P < 0.001). Multivariable adjusted HR for all-cause mortality was 1.217 (95% CI: 1.085-1.365, P < 0.001). Rates of bleeding were similar, with unadjusted RR 1.00 (95% CI: 0.919-1.087, P = 0.994) and adjusted HR 1.025 (95% CI: 0.898-1.170, P = 0.715). CONCLUSION: Non-paroxysmal atrial fibrillation is associated with a highly significant increase in thromboembolism and death. These data suggest the need for new therapies to prevent AF progression and further studies to explore the integration of AF type into models of thromboembolic risk.","author":[{"dropping-particle":"","family":"Ganesan","given":"Anand N","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chew","given":"Derek P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hartshorne","given":"Trent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Selvanayagam","given":"Joseph B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Aylward","given":"Philip E","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McGavigan","given":"Andrew D","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European heart journal","id":"ITEM-1","issue":"20","issued":{"date-parts":[["2016","5"]]},"language":"eng","page":"1591-1602","publisher-place":"England","title":"The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis.","type":"article-journal","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁹","plainTextFormattedCitation":"29","previouslyFormattedCitation":"²⁹"},"properties":{"noteIndex":0},"schema":""}29. Further, the classification of clinical AF influences rate/rhythm management and lack of concordance between the guidelines can be misleading in the evaluation of patients and differing management strategies between physicians.Evaluation of thromboembolic risk at baseline is very similar across all the guidelines with most adopting the CHA2DS2-VASc score, with the notable exception of Canadian guidelines. The almost universal adoption of CHA2DS2-VASc score reflects the strength of the current data supporting its’ use a clinical risk score that provides a balance between evidence, practicality and precisionADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0038-1676074","ISSN":"2567-689X","PMID":"30458556","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mujovic","given":"Nebojsa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Potpara","given":"Tatjana S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018","12","20"]]},"page":"2014-2017","title":"Optimizing Stroke and Bleeding Risk Assessment in Patients with Atrial Fibrillation: A Balance of Evidence, Practicality and Precision.","type":"article-journal","volume":"118"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁰","plainTextFormattedCitation":"30","previouslyFormattedCitation":"³⁰"},"properties":{"noteIndex":0},"schema":""}30. A recent comparative effectiveness review about the ability of the scores to predict thromboembolic and bleeding events reported that CHADS2, CHA2DS2-VASc and the recent ABC-StrokeADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCULATIONAHA.116.022802","ISSN":"0009-7322","PMID":"27569438","abstract":"BACKGROUND Atrial fibrillation is associated with increased but variable risk of stroke. Our aim was to validate the recently developed biomarker-based ABC (age, biomarkers [high-sensitivity troponin and N-terminal fragment B-type natriuretic peptide], and clinical history of prior stroke/transient ischemic attack)-stroke risk score and compare its performance with the CHA2DS2VASc and ATRIA (Anticoagulation and Risk Factors in Atrial Fibrillation) risk scores. METHODS The ABC-stroke score includes age, biomarkers (N-terminal fragment B-type natriuretic peptide and high-sensitivity cardiac troponin), and clinical history (prior stroke). This validation was based on 8356 patients, 16?137 person-years of follow-up, and 219 adjudicated stroke or systemic embolic events in anticoagulated patients with atrial fibrillation in the RE-LY study (Randomized Evaluation of Long-Term Anticoagulation Therapy). Levels of N-terminal fragment B-type natriuretic peptide, high-sensitivity cardiac troponin T (hs-cTnT), and high-sensitivity cardiac troponin I (hs-cTnI) were determined in plasma samples obtained at study entry. RESULTS The ABC-stroke score was well calibrated with 0.76 stroke/systemic embolic events per 100 person-years in the predefined low (<1%/y) risk group, 1.48 in the medium (1%-2%/y) risk group, and 2.60 in the high (>2%/y) risk group for the ABC-stroke score with hs-cTnT. Hazard ratios for stroke/systemic embolic events were 1.95 for medium- versus low-risk groups, and 3.44 for high- versus low-risk groups. ABC-stroke score achieved C indices of 0.65 with both hs-cTnT and hs-cTnI, in comparison with 0.60 for CHA2DS2VASc (P=0.004 for hs-cTnT and P=0.022 hs-cTnI) and 0.61 for ATRIA scores (P=0.005 hs-cTnT and P=0.034 for hs-cTnI). CONCLUSIONS The biomarker-based ABC-stroke score was well calibrated and consistently performed better than both the CHA2DS2VASc and ATRIA stroke scores. The ABC score should be considered an improved decision support tool in the care of patients with atrial fibrillation. CLINICAL TRIAL REGISTRATION URL: . Unique identifiers: ARISTOTLE, NCT00412984; RE-LY, NCT00262600.","author":[{"dropping-particle":"","family":"Oldgren","given":"Jonas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hijazi","given":"Ziad","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lindb?ck","given":"Johan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Alexander","given":"John H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart J.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Eikelboom","given":"John W.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ezekowitz","given":"Michael D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Granger","given":"Christopher B.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hylek","given":"Elaine M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lopes","given":"Renato D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siegbahn","given":"Agneta","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yusuf","given":"Salim","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wallentin","given":"Lars","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"RE-LY and ARISTOTLE Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation","id":"ITEM-1","issue":"22","issued":{"date-parts":[["2016","11"]]},"page":"1697-1707","title":"Performance and Validation of a Novel Biomarker-Based Stroke Risk Score for Atrial FibrillationClinical Perspective","type":"article-journal","volume":"134"},"uris":["",""]}],"mendeley":{"formattedCitation":"³¹","plainTextFormattedCitation":"31","previouslyFormattedCitation":"³¹"},"properties":{"noteIndex":0},"schema":""}31 scores were best and had a similar predictive capacity for stroke occurrenceADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0038-1675400","ISSN":"2567-689X","PMID":"30376678","abstract":"BACKGROUND ?Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke. Medical therapy for decreasing stroke risk involves anticoagulation, which may increase bleeding risk for certain patients. In determining the optimal therapy for stroke prevention for patients with AF, clinicians use tools with various clinical, imaging and patient characteristics to weigh stroke risk against therapy-associated bleeding risk. AIM ?This article reviews published literature and summarizes available risk stratification tools for stroke and bleeding prediction in patients with AF. METHODS ?We searched for English-language studies in PubMed, Embase and the Cochrane Database of Systematic Reviews published between 1 January 2000 and 14 February 2018. Two reviewers screened citations for studies that examined tools for predicting thromboembolic and bleeding risks in patients with AF. Data regarding study design, patient characteristics, interventions, outcomes, quality, and applicability were extracted. RESULTS ?Sixty-one studies were relevant to predicting thromboembolic risk and 38 to predicting bleeding risk. Data suggest that CHADS2, CHA2DS2-VASc and the age, biomarkers, and clinical history (ABC) risk scores have the best evidence for predicting thromboembolic risk (moderate strength of evidence for limited prediction ability of each score) and that HAS-BLED has the best evidence for predicting bleeding risk (moderate strength of evidence). LIMITATIONS ?Studies were heterogeneous in methodology and populations of interest, setting, interventions and outcomes analysed. CONCLUSION ?CHADS2, CHA2DS2-VASc and ABC scores have the best prediction for stroke events, and HAS-BLED provides the best prediction for bleeding risk. Future studies should define the role of imaging tools and biomarkers in enhancing the accuracy of risk prediction tools. PRIMARY FUNDING SOURCE ?Patient-Centered Outcomes Research Institute (PROSPERO #CRD42017069999).","author":[{"dropping-particle":"","family":"Borre","given":"Ethan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goode","given":"Adam","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Raitz","given":"Giselle","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shah","given":"Bimal","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lowenstern","given":"Angela","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chatterjee","given":"Ranee","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharan","given":"Lauren","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Allen LaPointe","given":"Nancy M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yapa","given":"Roshini","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Davis","given":"J Kelly","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lallinger","given":"Kathryn","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schmidt","given":"Robyn","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kosinski","given":"Andrzej","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Al-Khatib","given":"Sana M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Gillian D","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018","12","30"]]},"page":"2171-2187","title":"Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review.","type":"article-journal","volume":"118"},"uris":[""]}],"mendeley":{"formattedCitation":"³²","plainTextFormattedCitation":"32","previouslyFormattedCitation":"³²"},"properties":{"noteIndex":0},"schema":""}32. Nonetheless, CHA2DS2-VASc differs from other scores for its capacity to effectively identify those patients with very low risk and does not require expensive and time-consuming laboratory tests to be undertaken compared to the ABC-Stroke scoreADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0038-1676074","ISSN":"2567-689X","PMID":"30458556","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mujovic","given":"Nebojsa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Potpara","given":"Tatjana S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018","12","20"]]},"page":"2014-2017","title":"Optimizing Stroke and Bleeding Risk Assessment in Patients with Atrial Fibrillation: A Balance of Evidence, Practicality and Precision.","type":"article-journal","volume":"118"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁰","plainTextFormattedCitation":"30","previouslyFormattedCitation":"³⁰"},"properties":{"noteIndex":0},"schema":""}30. Furthermore, recently a systematic review and meta-regression demonstrated that CHA2DS2-VASc score represents the score with the highest probability to perform best in predicting the occurrence of all-cause death in AF patientsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1177/2047487318817662","ISSN":"2047-4873","abstract":"AimsMany clinical scores for risk stratification in patients with atrial fibrillation have been proposed, and some have been useful in predicting all-cause mortality. We aim to analyse the relationship between clinical risk score and all-cause death occurrence in atrial fibrillation patients.MethodsWe performed a systematic search in PubMed and Scopus from inception to 22 July 2017. We considered the following scores: ATRIA-Stroke, ATRIA-Bleeding, CHADS2, CHA2DS2-VASc, HAS-BLED, HATCH and ORBIT. Papers reporting data about scores and all-cause death rates were considered.ResultsFifty studies and 71 scores groups were included in the analysis, with 669,217 patients. Data on ATRIA-Bleeding, CHADS2, CHA2DS2-VASc and HAS-BLED were available. All the scores were significantly associated with an increased risk for all-cause death. All the scores showed modest predictive ability at five years (c-indexes (95% confidence interval) CHADS2: 0.64 (0.63–0.65), CHA2DS2-VASc: 0.62 (0.61–0.64), HAS-BLED: 0.62 (0.58–0.66)...","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farcomeni","given":"Alessio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romiti","given":"Giulio Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rocco","given":"Arianna","non-dropping-particle":"Di","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Placentino","given":"Filippo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Diemberger","given":"Igor","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory YH","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European Journal of Preventive Cardiology","id":"ITEM-1","issued":{"date-parts":[["2018","12"]]},"page":"204748731881766","publisher":"SAGE PublicationsSage UK: London, England","title":"Association between clinical risk scores and mortality in atrial fibrillation: Systematic review and network meta-regression of 669,000 patients","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"³³","plainTextFormattedCitation":"33","previouslyFormattedCitation":"³³"},"properties":{"noteIndex":0},"schema":""}33. The role of the female sex as an independent risk factor, in relation to stroke risk is addressed by all the seven guidelines examined (Table 2)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-3","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.hlc.2018.06.1043","ISSN":"1444-2892","PMID":"30077228","author":[{"dropping-particle":"","family":"NHFA CSANZ Atrial Fibrillation Guideline Working Group","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brieger","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Amerena","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Attia","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bajorek","given":"Beata","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chan","given":"Kim H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connell","given":"Cia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferguson","given":"Caleb","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hall","given":"Tanya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haqqani","given":"Haris","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hespe","given":"Charlotte","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hung","given":"Joseph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kalman","given":"Jonathan M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Worthington","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yan","given":"Tristan D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zwar","given":"Nicholas","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart, lung & circulation","id":"ITEM-4","issue":"10","issued":{"date-parts":[["2018","10"]]},"page":"1209-1266","title":"National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.","type":"article-journal","volume":"27"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-5","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-6","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]},{"id":"ITEM-7","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki 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The increased stroke risk in female AF patients has been long discussedADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"ISSN":"0340-6245","PMID":"19404530","author":[{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2009","5"]]},"page":"802-5","title":"Female gender is a risk factor for stroke and thromboembolism in atrial fibrillation patients.","type":"article-journal","volume":"101"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.2147/IJWH.S45925","ISSN":"1179-1411","PMID":"26089706","abstract":"Atrial fibrillation (AF) is the most common arrhythmia and has become a serious public health problem. Moreover, epidemiological data demonstrate that incidence and prevalence of AF are increasing. Several differences in epidemiological patterns, clinical manifestations, and incidence of stroke have been reported between AF in women and in men, particularly in elderly women. Elderly women have higher blood pressure than men and a higher prevalence of heart failure with preserved ejection fraction, both independent risk factors for stroke. On the basis of the evidence on the higher stroke risk among AF in women, recently, female sex has been accepted as a risk factor for stroke and adopted to stratify patients, especially if they are not at high risk for stroke. This review focuses on available evidence on sex differences in AF patients, and examines factors contributing to different stroke risk, diagnosis, and prognosis of arrhythmia in women, with the aim to provide an analysis of the available evidence.","author":[{"dropping-particle":"","family":"Poli","given":"Daniela","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Antonucci","given":"Emilia","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International journal of women's health","id":"ITEM-2","issued":{"date-parts":[["2015","1"]]},"page":"605-14","title":"Epidemiology, diagnosis, and management of atrial fibrillation in women.","type":"article-journal","volume":"7"},"uris":["",""]}],"mendeley":{"formattedCitation":"^34,35","plainTextFormattedCitation":"34,35","previouslyFormattedCitation":"^34,35"},"properties":{"noteIndex":0},"schema":""}34,35. A comprehensive meta-analysis including almost 1 million AF patients demonstrated that female patients with AF were at increased risk of stroke, with a 24% of relative risk increaseADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ijcard.2018.07.044","ISSN":"01675273","abstract":"Abstract Background Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, which is associated with an increased risk of stroke. Several studies have suggested that female AF patients could have a greater risk for stroke and thromboembolic events (TE). Methods A systematic literature review update and meta-analysis was conducted using Pubmed. The search used the terms \"atrial fibrillation\", \"gender\", \"sex\", \"female\", \"women\", \"stroke\", \"thromboembolism\". Main aim of the study was to compare and male AF patients for occurrence of stroke and TE. Secondary outcomes were: major bleeding, cardiovascular (CV) death and all-cause death. Results Forty-four studies were included in the analysis including 993,603 patients (48.9% women). After pooling the data, there was a higher risk of stroke for women vs. male AF patients (hazard ratio [HR]: 1.24; 95% confidence intervals [CIs]: 1.14–1.36). Overall, TE risk was not different between female and male patients, despite sensitivity analysis left some uncertainties. No sex differences were found for major bleeding, CV death and all-cause death. A significant relationship between increasing age and the difference in stroke risk between female and male AF patients was found (Delta HR: 1.01; 95% CI: 1.00–1.03 for each year of age increase). Conclusions Female patients with AF are at increased risk of stroke compared to men. A significant relationship between increasing age and stroke risk in women compared to men was found, most evident at age > 65 years. Female sex may act as a stroke risk modifier, particularly in elderly and very elderly AF subjects, conferring a significant increase in stroke risk.","author":[{"dropping-particle":"","family":"Marzona","given":"Irene","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farcomeni","given":"Alessio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romiti","given":"Giulio Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romanazzi","given":"Imma","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Raparelli","given":"Valeria","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Basili","given":"Stefania","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nobili","given":"Alessandro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Roncaglioni","given":"Maria Carla","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Cardiology","id":"ITEM-1","issued":{"date-parts":[["2018","7"]]},"publisher":"Elsevier","title":"Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation: A systematic review and meta-analysis of 993,600 patients","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"³⁶","plainTextFormattedCitation":"36","previouslyFormattedCitation":"³⁶"},"properties":{"noteIndex":0},"schema":""}36. However, a significant relationship was found between increasing age and a progressively higher risk of stroke in female AF patientsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ijcard.2018.07.044","ISSN":"01675273","abstract":"Abstract Background Atrial fibrillation (AF) is the most commonly diagnosed arrhythmia, which is associated with an increased risk of stroke. Several studies have suggested that female AF patients could have a greater risk for stroke and thromboembolic events (TE). Methods A systematic literature review update and meta-analysis was conducted using Pubmed. The search used the terms \"atrial fibrillation\", \"gender\", \"sex\", \"female\", \"women\", \"stroke\", \"thromboembolism\". Main aim of the study was to compare and male AF patients for occurrence of stroke and TE. Secondary outcomes were: major bleeding, cardiovascular (CV) death and all-cause death. Results Forty-four studies were included in the analysis including 993,603 patients (48.9% women). After pooling the data, there was a higher risk of stroke for women vs. male AF patients (hazard ratio [HR]: 1.24; 95% confidence intervals [CIs]: 1.14–1.36). Overall, TE risk was not different between female and male patients, despite sensitivity analysis left some uncertainties. No sex differences were found for major bleeding, CV death and all-cause death. A significant relationship between increasing age and the difference in stroke risk between female and male AF patients was found (Delta HR: 1.01; 95% CI: 1.00–1.03 for each year of age increase). Conclusions Female patients with AF are at increased risk of stroke compared to men. A significant relationship between increasing age and stroke risk in women compared to men was found, most evident at age > 65 years. Female sex may act as a stroke risk modifier, particularly in elderly and very elderly AF subjects, conferring a significant increase in stroke risk.","author":[{"dropping-particle":"","family":"Marzona","given":"Irene","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farcomeni","given":"Alessio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romiti","given":"Giulio Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romanazzi","given":"Imma","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Raparelli","given":"Valeria","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Basili","given":"Stefania","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nobili","given":"Alessandro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Roncaglioni","given":"Maria Carla","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Cardiology","id":"ITEM-1","issued":{"date-parts":[["2018","7"]]},"publisher":"Elsevier","title":"Sex differences in stroke and major adverse clinical events in patients with atrial fibrillation: A systematic review and meta-analysis of 993,600 patients","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"³⁶","plainTextFormattedCitation":"36","previouslyFormattedCitation":"³⁶"},"properties":{"noteIndex":0},"schema":""}36. Compelling data from the Danish registries demonstrated that while there were no profound differences between ‘low risk’ male and female AF patients with no additional stroke risk factors, a sex difference in stroke risk increased with the increasing number of risk factors, suggesting that female sex was “risk modifier” rather than a risk factor per seADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCULATIONAHA.117.029081","ISSN":"1524-4539","PMID":"29459469","abstract":"BACKGROUND Stroke risk in atrial fibrillation is assessed by using the CHA2DS2-VASc score. Sex category (Sc, ie, female sex) confers 1 point on CHA2DS2-VASc. We hypothesized that female sex is a stroke risk modifier, rather than an overall risk factor, when added to a CHA2DS2-VA (sex-independent thromboembolism risk) score scale. METHODS Using 3 nationwide registries, we identified patients with incident nonvalvular atrial fibrillation from January 1, 1997, through December 31, 2015. Patients receiving oral anticoagulant treatment at baseline were excluded, and person-time was censored at the time of treatment initiation (if any). CHA2DS2-VA scores were calculated for men and women, and were followed for up to 1 year in the Danish National Patient Registry. The primary outcome was a primary hospital code for ischemic stroke or systemic embolism (thromboembolism). We calculated crude event rates for risk strata as events per 100 person-years. For quantifying absolute risk of stroke, we calculated risks based on the pseudovalue method. Female sex as a prognostic factor was investigated by inclusion as an interaction term on the CHA2DS2-VA score to calculate the thromboembolic risk ratio for different score points. RESULTS A total of 239?671 patients with atrial fibrillation (48.7% women) contributed to the analyses. The mean ages for women and men were 76.6 years and 70.3 years, respectively; the mean CHA2DS2-VA scores were 2.7 for women and 2.3 for men. The overall 1-year thromboembolic rate per 100 person-years for women was 7.3 and 5.7 for men. The 1-year absolute risk of thromboembolism was 0.5% among men and women with a CHA2DS2-VA score of 0 and increased up to >7% among very comorbid patients (score >5). The risk ratio (male as reference) across points >1 indicated that women exhibit a higher stroke risk. The interaction was statistically significant (P<0.001). CONCLUSIONS Female sex is a risk modifier for stroke in patients with atrial fibrillation. Initial decisions on oral anticoagulant treatment could be guided by a CHA2DS2-VA score (ie, excluding the sex category criterion), but the Sc risk component modifies and accentuates stroke risk in women who would have been eligible for oral anticoagulant treatment on the basis of ≥2 additional stroke risk factors.","author":[{"dropping-particle":"","family":"Nielsen","given":"Peter Br?nnum","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skj?th","given":"Flemming","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Overvad","given":"Thure Filskov","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Larsen","given":"Torben Bjerregaard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation","id":"ITEM-1","issue":"8","issued":{"date-parts":[["2018","2","20"]]},"page":"832-840","title":"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?","type":"article-journal","volume":"137"},"uris":[""]}],"mendeley":{"formattedCitation":"³⁷","plainTextFormattedCitation":"37","previouslyFormattedCitation":"³⁷"},"properties":{"noteIndex":0},"schema":""}37. Ignoring the female sex criterion would underestimate stroke risk in female patients with ≥1 additional stroke risk factor(s), an important consideration when discussing risks with AF patients. The second pivotal step on which all the guidelines agree is the evaluation of baseline bleeding risk. While five out of 7 of the guidelines examined adopted HAS-BLED as the clinical risk score to evaluate bleeding riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-3","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-4","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff 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Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]},{"id":"ITEM-5","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki 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NHFA/CSANZ guidelines recognize the utility of the clinical scores to evaluate bleeding risk, but do not recommend the use of any particular scoreADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/eurheartj/ehw210","ISBN":"1099-5129","ISSN":"15229645","PMID":"27663299","abstract":"The Task Force for the 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 Endorsed by the European Stroke Organisation (ESO) 1 Preamble 102 Introduction 113 Epidemiology and impact for patients 12 3.1 Incidence and prevalence of atrial fibrillation 12 3.2 Morbidity, mortality, and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection 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4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 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We compared the relative predictive values of these bleeding risk scores for clinically relevant bleeding, as well as the relationship of ATRIA and ORBIT scores to the quality of anticoagulation control on warfarin, as reflected by time in therapeutic range (TTR). METHODS A post-hoc ancillary analysis of 'clinically relevant bleeding' and 'major bleeding' events amongst 2293 patients on warfarin therapy in the AMADEUS trial. RESULTS Only HAS-BLED was significantly predictive for clinically relevant bleeding, and all 3 risk scores were predictive for major bleeding. The predictive performance of HAS-BLED was modest, as reflected by c-indexes of 0.59 (p<0.001) and 0.65 (p<0.002), for clinically relevant bleeding and major bleeding, respectively. The HAS-BLED score performed better than ATRIA (P=0.002) or ORBIT (P=0.001) in predicting any clinically relevant bleeding. Only the HAS-BLED score was significantly associated with the risk for both bleeding outcomes on Cox regression analysis (any clinically relevant bleeding; hazard ratio [HR] 1.85, 95%CI 1.43-2.40, p<0.001, and major bleeding; HR 2.40, 95%CI 1.28-4.52, p=0.007). There were strong inverse correlations of ATRIA and ORBIT scores to TTR as a continuous variable ('low risk' ATRIA, r= -0.96; P=0.003; ORBIT, r= -0.96; p=0.003). Improvement in the predictive performance for both ATRIA and ORBIT scores for any clinically relevant bleeding was achieved by adding TTR to both scores, with significant differences in c-indexes (p=0.001 and p=0.002, respectively), NRI and IDI (both p<0.001). CONCLUSION All three bleeding risk prediction scores demonstrated modest predictive ability for bleeding outcomes, although the HAS-BLED score performed better than either the ATRIA or ORBIT scores. Significant improvements in both ATRIA and ORBIT score prediction performances were achieved by adding TTR to both scores.","author":[{"dropping-particle":"","family":"Senoo","given":"Keitaro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The American journal of medicine","id":"ITEM-1","issued":{"date-parts":[["2015","10"]]},"title":"Evaluation of the HAS-BLED, ATRIA and ORBIT bleeding risk scores in atrial fibrillation patients on warfarin.","type":"article-journal"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1038/srep24376","ISSN":"2045-2322","PMID":"27067661","abstract":"Bleeding risk represents a major concern in anticoagulated patients with atrial fibrillation (AF). Several bleeding prediction scores have been described: HAS-BLED, ATRIA, HEMORR2HAGES and ORBIT. Of these, only HAS-BLED considers quality of anticoagulation control amongst vitamin K antagonist (VKA) users. We hypothesised that predictive value of bleeding risk scores other than HAS-BLED could be improved incorporating time in therapeutic range (TTR) in warfarin-treated patients. Of the 127 adjudicated major bleeding events, 21.3% of events occurred in 'low-risk' HAS-BLED category (1.8 per 100 patient-years), compared to higher proportions (≥50% of events; ~2.5 per 100 patient-years) in 'low-risk' categories for other scores. Only the 'low-risk' HAS-BLED category was associated with the absence of investigator-defined major bleeding events (OR: 1.46;95% CI: 1.00-2.15). 'High' or 'medium/high' risk categories for the HAS-BLED (p?=?0.023) or ORBIT (p?=?0.022) scores, respectively, conferred significant risk for adjudicated major bleeding events. On Cox regression analysis, adjudicated major bleeding was associated only with HAS-BLED (HR: 1.62;95% CI: 1.06-2.48) and ORBIT (HR: 1.83;95% CI: 1.08-3.09) 'high-risk' categories. Adding 'labile INR' (TTR?<?65%) to ORBIT, ATRIA and HEMORR2HAGES significantly improved their reclassification and discriminatory performances. In conclusion, HAS-BLED categorised adjudicated major bleeding events in low-risk and high-risk patients appropriately, whilst ORBIT and ATRIA categorised most major bleeds into their 'low-risk' patient categories. Adding TTR to ORBIT, ATRIA and HEMORR2HAGES led to improved predictive performance for major bleeding.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Senoo","given":"Keitaro","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Scientific reports","id":"ITEM-2","issued":{"date-parts":[["2016","1","12"]]},"language":"en","page":"24376","publisher":"Nature Publishing Group","title":"Major Bleeding in Patients with Non-Valvular Atrial Fibrillation: Impact of Time in Therapeutic Range on Contemporary Bleeding Risk Scores.","type":"article-journal","volume":"6"},"uris":[""]}],"mendeley":{"formattedCitation":"^38,39","plainTextFormattedCitation":"38,39","previouslyFormattedCitation":"^38,39"},"properties":{"noteIndex":0},"schema":""}38,39 and to the most recent ABC-Bleeding and GARFIELD-AF Bleeding scores.ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1160/th17-07-0478","ISBN":"0340-6245","abstract":"Risk scores in patients with atrial fibrillation (AF) based on clinical factors alone generally have only modest predictive value for predicting high risk patients that sustain events. Biomarkers might be an attractive prognostic tool to improve bleeding risk prediction. The new ABC-Bleeding score performed better than HAS-BLED score in a clinical trial cohort but has not been externally validated. The aim of this study was to analyze the predictive performance of the ABC-Bleeding score compared to HAS-BLED score in an independent real-world anticoagulated AF patients with long-term follow-up. We enrolled 1,120 patients stable on vitamin K antagonist treatment. The HAS-BLED and ABC-Bleeding scores were quantified. Predictive values were compared by c-indexes, IDI, NRI, as well as decision curve analysis (DCA). Median HAS-BLED score was 2 (IQR 2-3) and median ABC-Bleeding was 16.5 (IQR 14.3-18.6). After 6.5 years of follow-up, 207 (2.84 \\% /year) patients had major bleeding events, of which 65 (0.89 \\% /year) had intracranial haemorrhage (ICH) and 85 (1.17 \\% /year) had gastrointestinal bleeding events (GIB). The c-index of HAS-BLED was significantly higher than ABC-Bleeding for major bleeding (0.583 vs 0.518; p=0.025), GIB (0.596 vs 0.519; p=0.017) and for the composite of ICH-GIB (0.593 vs 0.527; p=0.030). NRI showed a significant negative reclassification for major bleeding and for the composite of ICH-GIB with the ABC-Bleeding score compared to HAS-BLED. Using DCAs, the use of HAS-BLED score gave an approximate net benefit of 4 \\% over the ABC-Bleeding score. In conclusion, in the first real-world validation of the ABC-Bleeding score, HAS-BLED performed significantly better than the ABC-Bleeding score in predicting major bleeding, GIB and the composite of GIB and ICH.","author":[{"dropping-particle":"","family":"Esteve-Pastor","given":"M A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rivera-Caravaca","given":"J M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Roldan","given":"V","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vicente","given":"V","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Valdes","given":"M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Marin","given":"F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thromb Haemost","edition":"2017/08/12","id":"ITEM-1","issue":"10","issued":{"date-parts":[["2017"]]},"page":"1848-1858","title":"Long-term bleeding risk prediction in 'real world' patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project","type":"article-journal","volume":"117"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1161/JAHA.118.009766","ISSN":"2047-9980","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rivera‐Caravaca","given":"José Miguel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Esteve‐Pastor","given":"María Asunción","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romiti","given":"Giulio Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Marin","given":"Francísco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y. H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American Heart Association","id":"ITEM-2","issue":"18","issued":{"date-parts":[["2018","9"]]},"title":"Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores","type":"article-journal","volume":"7"},"uris":["",""]}],"mendeley":{"formattedCitation":"^40,41","plainTextFormattedCitation":"40,41","previouslyFormattedCitation":"^40,41"},"properties":{"noteIndex":0},"schema":""}40,41 Furthermore, when compared to an approach based exclusively on modifiable bleeding risk factors as promoted by the ESC guidelines, using the HAS-BLED score was a superior strategy for bleeding risk assessment ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1055/s-0038-1636534","ISSN":"2567-689X","PMID":"29510426","abstract":"AIM ?When assessing bleeding risk in patients with atrial fibrillation (AF), risk stratification is often based on the baseline risks. We aimed to investigate changes in bleeding risk factors and alterations in the HAS-BLED score in AF patients. We hypothesized that a follow-up HAS-BLED score and the 'delta HAS-BLED score' (reflecting the change in score between baseline and follow-up) would be more predictive of major bleeding, when compared with baseline HAS-BLED score. METHODS AND RESULTS ?A total of 19,566 AF patients receiving warfarin and baseline HAS-BLED score ≤2 were studied. After a follow-up of 93,783 person-years, 3,032 major bleeds were observed. The accuracies of baseline, follow-up, and delta HAS-BLED scores as well as cumulative numbers of baseline modifiable bleeding risk factors, in predicting subsequent major bleeding, were analysed and compared. The mean baseline HAS-BLED score was 1.43 which increased to 2.45 with a mean 'delta HAS-BLED score' of 1.03. The HAS-BLED score remained unchanged in 38.2% of patients. Of those patients experiencing major bleeding, 76.6% had a 'delta HAS-BLED' score ≥1, compared with only 59.0% in patients without major bleeding (p?<?0.001). For prediction of major bleeding, AUC was significantly higher for the follow-up HAS-BLED (0.63) or delta HAS-BLED (0.62) scores, compared with baseline HAS-BLED score (0.54). The number of baseline modifiable risk factors was non-significantly predictive of major bleeding (AUC?=?0.49). CONCLUSION ?In this 'real-world' nationwide AF cohort, follow-up HAS-BLED or 'delta HAS-BLED score' was more predictive of major bleeding compared with baseline HAS-BLED or the simple determination of 'modifiable bleeding risk factors'. Bleeding risk in AF is a dynamic process and use of the HAS-BLED score should be to 'flag up' patients potentially at risk for more regular review and follow-up, and to address the modifiable bleeding risk factors during follow-up visits.","author":[{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lin","given":"Yenn-Jiang","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chang","given":"Shih-Lin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lo","given":"Li-Wei","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hu","given":"Yu-Feng","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tuan","given":"Ta-Chuan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Liao","given":"Jo-Nan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chung","given":"Fa-Po","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"Tzeng-Ji","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"Shih-Ann","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","4","6"]]},"page":"768-777","title":"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.","type":"article-journal","volume":"118"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1160/TH17-10-0710","ISSN":"2567-689X","PMID":"29212113","abstract":"Background?The HAS-BLED (hypertension, abnormal renal/liver function, previous stroke, bleeding history or predisposition, labile international normalized ratio [INR], elderly and drugs/alcohol consumption) score has been validated in several scenarios but the recent European guidelines does not recommend any clinical score to assess bleeding risk in atrial fibrillation (AF) patients and only focus on modifiable clinical factors. Purpose?The aim of this study was to test the hypothesis that the HAS-BLED score would perform at least similarly to an approach only based on modifiable bleeding risk factors (i.e. a ‘modifiable bleeding risk factors score’) for predicting bleeding events. Methods?We performed a comparison between the HAS-BLED score and the new ‘modifiable bleeding risk factors score’ in a post hoc analysis in 4,576 patients included in the AMADEUS trial. Results?After 347 (interquartile range, 186–457) days of follow-up, 597 patients (13.0%) experienced any clinically relevant bleeding event and 113 (2.5%) had a major bleeding. Only the HAS-BLED score was significantly associated with the risk of any clinically relevant bleeding (Cox's analysis for HAS-BLED ≥?3: hazard ratio 1.38; 95% confidence interval [CI], 1.10–1.72; p?=?0.005). The ‘modifiable bleeding risk factors score’ ≥?2 were non-significantly associated with any clinical relevant bleeding. The two scores had modest ability in predicting bleeding events. The HAS-BLED score performed best in predicting any clinically relevant bleeding (c-indexes for HAS-BLED, 0.545 [95% CI, 0.530–0.559] vs. the ‘modifiable bleeding risk factors score’, 0.530 [95% CI, 0.515–0.544]; c-index difference 0.015, z-score?=?2.063, p?=?0.04). The HAS-BLED score with one, two and three modifiable factors performed significantly better than the ‘modifiable bleeding risk factors scores’ with one, two and three modifiable risk factors. Conclusion?When compared with an approach only based on modifiable bleeding risk factors proposed by European Society of Cardiology (ESC) AF guidelines, the HAS-BLED score performed significantly better in predicting any clinically relevant bleeding in this clinical trial cohort. While modifiable bleeding risk factors should be addressed in all AF patients, the use of a formal bleeding risk score (HAS-BLED) has better predictive value for bleeding risks, and would help decision-making in identifying ‘high risk’ patients for scheduling reviews and follow-up.","author":[{"dropping-particle":"","family":"Esteve-Pastor","given":"María Asunción","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rivera-Caravaca","given":"José Miguel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shantsila","given":"Alena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Roldán","given":"Vanessa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Marín","given":"Francisco","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2017","12","6"]]},"page":"2261-2266","title":"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.","type":"article-journal","volume":"117"},"uris":[""]}],"mendeley":{"formattedCitation":"^42,43","plainTextFormattedCitation":"42,43","previouslyFormattedCitation":"^42,43"},"properties":{"noteIndex":0},"schema":""}42,43.Regarding the prescription of OAC, the Canadian guidelines still recommend prescribing antiplatelet drugs in patients aged <65 years with isolated CAD and no other stroke risk factorsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,18","plainTextFormattedCitation":"13,18","previouslyFormattedCitation":"^13,18"},"properties":{"noteIndex":0},"schema":""}13,18, but all other guidelines support the prescription of OAC in patients with at least one stroke risk factor not related to gender. All the recommendations regarding OAC prescription are strong recommendations and hence supported by solid evidence. Similarly, as largely supported by Phase III randomized clinical trialsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0140-6736(13)62343-0","ISSN":"1474-547X","PMID":"24315724","abstract":"BACKGROUND: Four new oral anticoagulants compare favourably with warfarin for stroke prevention in patients with atrial fibrillation; however, the balance between efficacy and safety in subgroups needs better definition. We aimed to assess the relative benefit of new oral anticoagulants in key subgroups, and the effects on important secondary outcomes. METHODS: We searched Medline from Jan 1, 2009, to Nov 19, 2013, limiting searches to phase 3, randomised trials of patients with atrial fibrillation who were randomised to receive new oral anticoagulants or warfarin, and trials in which both efficacy and safety outcomes were reported. We did a prespecified meta-analysis of all 71 683 participants included in the RE-LY, ROCKET AF, ARISTOTLE, and ENGAGE AF-TIMI 48 trials. The main outcomes were stroke and systemic embolic events, ischaemic stroke, haemorrhagic stroke, all-cause mortality, myocardial infarction, major bleeding, intracranial haemorrhage, and gastrointestinal bleeding. We calculated relative risks (RRs) and 95% CIs for each outcome. We did subgroup analyses to assess whether differences in patient and trial characteristics affected outcomes. We used a random-effects model to compare pooled outcomes and tested for heterogeneity. FINDINGS: 42 411 participants received a new oral anticoagulant and 29 272 participants received warfarin. New oral anticoagulants significantly reduced stroke or systemic embolic events by 19% compared with warfarin (RR 0·81, 95% CI 0·73-0·91; p<0·0001), mainly driven by a reduction in haemorrhagic stroke (0·49, 0·38-0·64; p<0·0001). New oral anticoagulants also significantly reduced all-cause mortality (0·90, 0·85-0·95; p=0·0003) and intracranial haemorrhage (0·48, 0·39-0·59; p<0·0001), but increased gastrointestinal bleeding (1·25, 1·01-1·55; p=0·04). We noted no heterogeneity for stroke or systemic embolic events in important subgroups, but there was a greater relative reduction in major bleeding with new oral anticoagulants when the centre-based time in therapeutic range was less than 66% than when it was 66% or more (0·69, 0·59-0·81 vs 0·93, 0·76-1·13; p for interaction 0·022). Low-dose new oral anticoagulant regimens showed similar overall reductions in stroke or systemic embolic events to warfarin (1·03, 0·84-1·27; p=0·74), and a more favourable bleeding profile (0·65, 0·43-1·00; p=0·05), but significantly more ischaemic strokes (1·28, 1·02-1·60; p=0·045). INTERPRETATION: This meta-analysis is the first to inclu…","author":[{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Giugliano","given":"Robert P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Braunwald","given":"Eugene","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hoffman","given":"Elaine B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Deenadayalu","given":"Naveen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ezekowitz","given":"Michael D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weitz","given":"Jeffrey I","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lewis","given":"Basil S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkhomenko","given":"Alexander","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Yamashita","given":"Takeshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Antman","given":"Elliott M","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet","id":"ITEM-1","issued":{"date-parts":[["2013","12"]]},"title":"Comparison of the efficacy and safety of new oral anticoagulants with warfarin in patients with atrial fibrillation: a meta-analysis of randomised trials.","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"²","plainTextFormattedCitation":"2","previouslyFormattedCitation":"²"},"properties":{"noteIndex":0},"schema":""}2 and observational studiesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1160/TH16-03-0203","ISSN":"0340-6245 (Print)","PMID":"27465747","abstract":"In the RE-LY clinical trial, dabigatran presented a better effectiveness/safety profile when compared to warfarin. However, clinical trials are not very representative of the real-world setting. We aimed to assess the performance of dabigatran in real-world patients with atrial fibrillation (AF) by means of a systematic review and meta-analysis of observational comparison studies with vitamin K antagonists (VKA). We searched PubMed, Embase and Scopus databases until November 2015 and selected studies according to the following criteria: observational study performed with nonvalvular AF patients; reporting adjusted hazard ratios (HR) of clinical events in a follow-up period; for dabigatran 75 mg, 110 mg or 150 mg versus VKA. Twenty studies were selected which included 711,298 patients, 210,279 of which were treated with dabigatran and the remaining 501,019 with VKA. Ischaemic stroke incidence was of 1.65 /100 patient-years for dabigatran and 2.85/100 patient-years for VKA (HR 0.86, 95 % confidence interval of 0.74-0.99). Major bleeding rate was 3.93/100 patient-years for dabigatran and 5.61/100 patient-years for VKA (0.79, 0.69-0.89). Risk of mortality (0.73, 0.61-0.87) and intracranial bleeding (0.45, 0.38-0.52) were significantly lower in patients treated with dabigatran when compared to patients on VKA. Risk of gastrointestinal (GI) bleeding was significantly higher in patients treated with dabigatran (1.13, 1.00-1.28). No significant difference was observed in risk of myocardial infarction (0.99, 0.89-1.11). In this combined analysis of real-world observational comparison studies with VKA, dabigatran was associated with a lower risk of ischaemic stroke, major bleeding, intracranial bleeding and mortality, higher risk of GI bleeding and a similar risk of myocardial infarction.","author":[{"dropping-particle":"","family":"Carmo","given":"Joao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moscoso Costa","given":"Francisco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ferreira","given":"Jorge","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mendes","given":"Miguel","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2016","9"]]},"language":"eng","page":"754-763","publisher-place":"Germany","title":"Dabigatran in real-world atrial fibrillation. Meta-analysis of observational comparison studies with vitamin K antagonists.","type":"article-journal","volume":"116"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1161/STROKEAHA.116.016275","ISSN":"0039-2499","PMID":"28213573","abstract":"BACKGROUND AND PURPOSE This study was designed to evaluate the effectiveness and safety of rivaroxaban in real-world practice compared with effectiveness and safety of dabigatran or warfarin for stroke prevention in atrial fibrillation through meta-analyzing observational studies. METHODS Seventeen studies were included after searching in PubMed for studies reporting the comparative effectiveness and safety of rivaroxaban versus dabigatran (n=3), rivaroxaban versus Warfarin (n=11), or both (n=3) for stroke prevention in atrial fibrillation. RESULTS Overall, the risks of stroke/systematic thromboembolism with rivaroxaban were similar when compared with those with dabigatran (stroke/thromboembolism: hazard ratio, 1.02; 95% confidence interval, 0.91-1.13; I(2)=70.2%, N=5), but were significantly reduced when compared with those with warfarin (hazard ratio, 0.75; 95% confidence interval, 0.64-0.85; I(2)=45.1%, N=9). Major bleeding risk was significantly higher with rivaroxaban than with dabigatran (hazard ratio, 1.38; 95% confidence interval, 1.27-1.49; I(2)=26.1%, N=5), but similar to that with warfarin (hazard ratio, 0.99; 95% confidence interval, 0.91-1.07; I(2)=0.0%, N=6). Rivaroxaban was associated with increased all-cause mortality and gastrointestinal bleeding, but similar risk of acute myocardial infarction and intracranial hemorrhage when compared with dabigatran. When compared with warfarin, rivaroxaban was associated with similar risk of any bleeding, mortality, and acute myocardial infarction, but a higher risk of gastrointestinal bleeding and lower risk of intracranial hemorrhage. CONCLUSIONS In this systematic review and meta-analysis, rivaroxaban was as effective as dabigatran, but was more effective than warfarin for the prevention of stroke/thromboembolism in atrial fibrillation patients. Major bleeding risk was significantly higher with rivaroxaban than with dabigatran, as was all-cause mortality and gastrointestinal bleeding. Rivaroxaban was comparable to warfarin for major bleeding, with an increased risk in gastrointestinal bleeding and decreased risk of intracranial hemorrhage.","author":[{"dropping-particle":"","family":"Bai","given":"Ying","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Deng","given":"Hai","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shantsila","given":"Alena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Stroke","id":"ITEM-2","issue":"4","issued":{"date-parts":[["2017","4"]]},"page":"970-976","title":"Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation","type":"article-journal","volume":"48"},"uris":["",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1161/STROKEAHA.117.018395","ISBN":"1524-4628 (Electronic) 0039-2499 (Linking)","ISSN":"15244628","PMID":"29167388","abstract":"BACKGROUND AND PURPOSE The use of oral anticoagulant therapy for stroke prevention in atrial fibrillation has been transformed by the availability of the nonvitamin K antagonist oral anticoagulants. Real-world studies on the use of nonvitamin K antagonist oral anticoagulants would help elucidate their effectiveness and safety in daily clinical practice. Apixaban was the third nonvitamin K antagonist oral anticoagulants introduced to clinical practice, and increasing real-world studies have been published. Our aim was to summarize current evidence about real-world studies on apixaban for stroke prevention in atrial fibrillation. METHODS We performed a systematic review and meta-analysis of all observational real-world studies comparing apixaban with other available oral anticoagulant drugs. RESULTS From the original 9680 results retrieved, 16 studies have been included in the final meta-analysis. Compared with warfarin, apixaban regular dose was more effective in reducing any thromboembolic event (odds ratio: 0.77; 95% confidence interval: 0.64-0.93), but no significant difference was found for stroke risk. Apixaban was as effective as dabigatran and rivaroxaban in reducing thromboembolic events and stroke. The risk of major bleeding was significantly lower for apixaban compared with warfarin, dabigatran, and rivaroxaban (relative risk reduction, 38%, 35%, and 46%, respectively). Similarly, the risk for intracranial hemorrhage was significantly lower for apixaban than warfarin and rivaroxaban (46% and 54%, respectively) but not dabigatran. The risk of gastrointestinal bleeding was lower with apixaban when compared with all oral anticoagulant agents (P<0.00001 for all comparisons). CONCLUSIONS Use of apixaban in real-life is associated with an overall similar effectiveness in reducing stroke and any thromboembolic events when compared with warfarin. A better safety profile was found with apixaban compared with warfarin, dabigatran, and rivaroxaban.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romanazzi","given":"Imma","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romiti","given":"Giulio Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farcomeni","given":"Alessio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Stroke","id":"ITEM-3","issue":"1","issued":{"date-parts":[["2018"]]},"page":"98-106","title":"Real-world use of apixaban for stroke prevention in atrial fibrillation: A systematic review and meta-analysis","type":"article-journal","volume":"49"},"uris":["",""]}],"mendeley":{"formattedCitation":"^44–46","plainTextFormattedCitation":"44–46","previouslyFormattedCitation":"^44–46"},"properties":{"noteIndex":0},"schema":""}44–46, all the guidelines recommend the use of NOACs in preference to VKAs. Notwithstanding that globally VKAs are still widely used as OAC, the use of the SAMe-TT2R2 score is mentioned in some guidelines related to where VKAs are used to help assess the likelihood of patients to achieve an optimal anticoagulation control when prescribed with VKAs, that could guide more intense INR monitoring or the alternative prescription of VKAs and NOACsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.hrthm.2017.11.026","ISSN":"15475271","PMID":"29180122","abstract":"Identifying patients who are likely to achieve and maintain a therapeutic international normalized ratio when prescribed a vitamin K antagonist for stroke prevention in atrial fibrillation (AF) and venous thromboembolism (VTE) is challenging. The SAMe-TT2R2 score was developed on the basis of common clinical factors that can highlight patients who may be unable to achieve and maintain good anticoagulation control and for whom a \"trial of warfarin\" would be inadvisable. This review summarizes the main published prospective and retrospective studies that have validated the SAMe-TT2R2 score in patients with AF and VTE treated with a vitamin K antagonist and how the SAMe-TT2R2 score could aid clinical decision making; 19 studies were included. Taken together, validation studies suggest that the SAMe-TT2R2 score is able to predict good or poor anticoagulation control in patients with AF and VTE, although data on patients with VTE are limited (3 studies). The available evidence suggests that the SAMe-TT2R2 score may be a useful tool to aid clinical decision making for oral anticoagulants in patients with AF and VTE.","author":[{"dropping-particle":"","family":"Zulkifly","given":"Hanis","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart Rhythm","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","4"]]},"page":"615-623","title":"Use of the SAMe-TT 2 R 2 score to predict anticoagulation control in atrial fibrillation and venous thromboembolism patients receiving vitamin K antagonists: A review","type":"article-journal","volume":"15"},"uris":["",""]}],"mendeley":{"formattedCitation":"⁴⁷","plainTextFormattedCitation":"47","previouslyFormattedCitation":"⁴⁷"},"properties":{"noteIndex":0},"schema":""}47.On the basis of the guideline recommendations and evidence presented, and given that the default should be to offer stroke prevention unless the patient is ‘low risk’, the so-called ‘Birmingham 3-Step’ management strategy has been advocated [Figure 2]ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1160/TH16-11-0876","ISSN":"2567-689X","PMID":"28597905","abstract":"Concepts and our approaches to stroke prevention in atrial fibrillation (AF) have changed markedly over the last decade. There has been an evolution over the approach to stroke and bleeding risk assessment, as well as new treatment options. An increasing awareness of AF has led to calls to improve the detection of and population screening for AF. Stroke and bleeding risk assessment continues to evolve, and the ongoing debate on balance between simplicity and practicality, against precision medicine will continue. In this review article, we provide an overview of past, present and the (likely) future concepts and approaches to stroke prevention in AF. We propose three simple steps (the Birmingham '3-step') that offers a practical management pathway to help streamline and simplify decision-making for stroke prevention in patients with AF.","author":[{"dropping-particle":"","family":"Lip","given":"Gregory","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Caterina","given":"Raffaele","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Potpara","given":"Tatjana S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-1","issue":"7","issued":{"date-parts":[["2017","6","28"]]},"page":"1230-1239","title":"Stroke prevention in atrial fibrillation: Past, present and future. Comparing the guidelines and practical decision-making.","type":"article-journal","volume":"117"},"uris":[""]}],"mendeley":{"formattedCitation":"¹","plainTextFormattedCitation":"1","previouslyFormattedCitation":"¹"},"properties":{"noteIndex":0},"schema":""}1. In the first step, AF patients who are low risk are identified through CHA2DS2-VASc score, and no antithrombotic therapy is recommended. In the second step, OAC therapy is considered in all AF patients with at least 1 additional non-sex stroke risk factor(s) and risk of bleeding is assessed, to identify those patients at high risk of bleeding (HAS-BLED ≥3), to address modifiable bleeding risk factors and plan more frequent follow-up checks. In the third step, treatment with OAC should be started with NOACs as the preferred option – and if a VKA is considered, the SAMe-TT2R2 score can help to identify those patients that would more likely obtain a low TTR (SAMe-TT2R2 >2) who can be identified for more regular INR monitoring, education/counselling or to reconsider being prescribed a NOAC.Regarding the concomitant use of OAC and antiplatelet drugs, the guidelines examined agree on similar basis. It is recognized that the use of triple antithrombotic therapy in AF with ACS should be based on the balance between atherothrombotic/thromboembolic risk and bleeding risk and that such strategy should be kept as short as possible.Use of triple antithrombotic therapy has been traditionally associated to an increased risk of bleeding, with several studies reporting an increased rate of major bleeding events with no relative benefit in terms of thromboembolic and atherosclerotic events)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0140-6736(12)62177-1","ISSN":"1474-547X","PMID":"23415013","abstract":"BACKGROUND: If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with clopidogrel plus aspirin.\nMETHODS: We did an open-label, multicentre, randomised, controlled trial in 15 centres in Belgium and the Netherlands. From November, 2008, to November, 2011, adults receiving oral anticoagulants and undergoing PCI were assigned clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). The primary outcome was any bleeding episode within 1 year of PCI, assessed by intention to treat. This study is registered with , number NCT00769938.\nFINDINGS: 573 patients were enrolled and 1-year data were available for 279 (98·2%) patients assigned double therapy and 284 (98·3%) assigned triple therapy. Mean ages were 70·3 (SD 7·0) years and 69·5 (8·0) years, respectively. Bleeding episodes were seen in 54 (19·4%) patients receiving double therapy and in 126 (44·4%) receiving triple therapy (hazard ratio [HR] 0·36, 95% CI 0·26-0·50, p<0·0001). In the double-therapy group, six (2·2%) patients had multiple bleeding events, compared with 34 (12·0%) in the triple-therapy group. 11 (3·9%) patients receiving double therapy required at least one blood transfusion, compared with 27 (9·5%) patients in the triple-therapy group (odds ratio from Kaplan-Meier curve 0·39, 95% CI 0·17-0·84, p=0·011).\nINTERPRETATION: Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events.\nFUNDING: Antonius Ziekenhuis Foundation, Strect Foundation.","author":[{"dropping-particle":"","family":"Dewilde","given":"Willem J M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oirbans","given":"Tom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verheugt","given":"Freek W A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kelder","given":"Johannes C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smet","given":"Bart J G L","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Herrman","given":"Jean-Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Adriaenssens","given":"Tom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vrolix","given":"Mathias","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Heestermans","given":"Antonius A C M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vis","given":"Marije M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tijsen","given":"Jan G P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"'t Hof","given":"Arnoud W","non-dropping-particle":"van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Berg","given":"Jurri?n M","non-dropping-particle":"ten","parse-names":false,"suffix":""},{"dropping-particle":"","family":"WOEST study investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet","id":"ITEM-1","issue":"9872","issued":{"date-parts":[["2013","3"]]},"language":"eng","page":"1107-1115","title":"Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial","type":"article-journal","volume":"381"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.ahj.2017.05.016","ISSN":"00028703","abstract":"? 2017 Elsevier Inc. Background Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the impact of time in therapeutic range (TTR) on outcomes, in patients prescribed with TAT. Methods Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome. Results Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P?=?.006). Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P?=?.006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P?=?.086). Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P?=?.050 and HR: 0.21, P?=?.005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P? < ?.001). For MACCE, adjusted Cox analysis found a non-significant lower risk for T3 (HR: 0.64, P?=?.128). Conclusions In AF patients undergoing PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) was closely related to bleeding outcomes during follow-up. Despite some suggestive trends for an inverse relationship between TTR and MACCE, no definitive conclusions can be drawn, and further large studies are needed.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Airaksinen","given":"K.E.J. Juhani","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rubboli","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schlitt","given":"Axel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kiviniemi","given":"Tuomas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Karjalainen","given":"Pasi P.P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory YH G.Y.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Heart Journal","id":"ITEM-2","issued":{"date-parts":[["2017","8"]]},"page":"86-93","title":"Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry","type":"article-journal","volume":"190"},"uris":["",""]}],"mendeley":{"formattedCitation":"^48,49","plainTextFormattedCitation":"48,49","previouslyFormattedCitation":"^48,49"},"properties":{"noteIndex":0},"schema":""}48,49. For example, the WOEST trial reported that a strategy of clopidogrel plus OAC compared to triple antithrombotic therapy was associated with a lower risk of major bleeding with no difference in terms of efficacyADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0140-6736(12)62177-1","ISSN":"1474-547X","PMID":"23415013","abstract":"BACKGROUND: If percutaneous coronary intervention (PCI) is required in patients taking oral anticoagulants, antiplatelet therapy with aspirin and clopidogrel is indicated, but such triple therapy increases the risk of serious bleeding. We investigated the safety and efficacy of clopidogrel alone compared with clopidogrel plus aspirin.\nMETHODS: We did an open-label, multicentre, randomised, controlled trial in 15 centres in Belgium and the Netherlands. From November, 2008, to November, 2011, adults receiving oral anticoagulants and undergoing PCI were assigned clopidogrel alone (double therapy) or clopidogrel plus aspirin (triple therapy). The primary outcome was any bleeding episode within 1 year of PCI, assessed by intention to treat. This study is registered with , number NCT00769938.\nFINDINGS: 573 patients were enrolled and 1-year data were available for 279 (98·2%) patients assigned double therapy and 284 (98·3%) assigned triple therapy. Mean ages were 70·3 (SD 7·0) years and 69·5 (8·0) years, respectively. Bleeding episodes were seen in 54 (19·4%) patients receiving double therapy and in 126 (44·4%) receiving triple therapy (hazard ratio [HR] 0·36, 95% CI 0·26-0·50, p<0·0001). In the double-therapy group, six (2·2%) patients had multiple bleeding events, compared with 34 (12·0%) in the triple-therapy group. 11 (3·9%) patients receiving double therapy required at least one blood transfusion, compared with 27 (9·5%) patients in the triple-therapy group (odds ratio from Kaplan-Meier curve 0·39, 95% CI 0·17-0·84, p=0·011).\nINTERPRETATION: Use of clopiogrel without aspirin was associated with a significant reduction in bleeding complications and no increase in the rate of thrombotic events.\nFUNDING: Antonius Ziekenhuis Foundation, Strect Foundation.","author":[{"dropping-particle":"","family":"Dewilde","given":"Willem J M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oirbans","given":"Tom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verheugt","given":"Freek W A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kelder","given":"Johannes C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Smet","given":"Bart J G L","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Herrman","given":"Jean-Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Adriaenssens","given":"Tom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vrolix","given":"Mathias","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Heestermans","given":"Antonius A C M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vis","given":"Marije M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tijsen","given":"Jan G P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"'t Hof","given":"Arnoud W","non-dropping-particle":"van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Berg","given":"Jurri?n M","non-dropping-particle":"ten","parse-names":false,"suffix":""},{"dropping-particle":"","family":"WOEST study investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet","id":"ITEM-1","issue":"9872","issued":{"date-parts":[["2013","3"]]},"language":"eng","page":"1107-1115","title":"Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial","type":"article-journal","volume":"381"},"uris":[""]}],"mendeley":{"formattedCitation":"⁴⁸","plainTextFormattedCitation":"48","previouslyFormattedCitation":"⁴⁸"},"properties":{"noteIndex":0},"schema":""}48. Nevertheless, if good quality anticoagulation control is attained, the risk of major bleeding in such patients undergoing PCI and stent seems to be significantly reducedADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ahj.2017.05.016","ISSN":"00028703","abstract":"? 2017 Elsevier Inc. Background Combination of oral anticoagulation (OAC) and antiplatelets is used in atrial fibrillation (AF) patients undergoing percutaneous coronary intervention and stent (PCI-S) procedure but is associated with increased bleeding when triple antithrombotic therapy (TAT) is used. Our aim was to analyze the impact of time in therapeutic range (TTR) on outcomes, in patients prescribed with TAT. Methods Ancillary analysis from the AFCAS registry in patients assigned to TAT. TTR was calculated with Rosendaal method. Outcomes were analyzed according to TTR tertiles (T1 [≤56.8%] vs. T2 [56.9–93.8%] vs. T3 [≥93.9%]). Major bleeding was the primary outcome. Results Of 963 patients enrolled, 470(48.8%) were prescribed with TAT at discharge and qualified for this analysis. Median [IQR] TTR was 80.0% [45.3–100%]. After 359 [341–370] days, major bleeding rates were progressively lower with increasing TTR tertiles (T1 vs. T2 vs. T3: 10.3% vs. 4.7% vs. 2.3%, P?=?.006). Kaplan–Meier analysis demonstrated a progressively lower risk for major bleeding across tertiles (P?=?.006). Patients in the highest TTR tertile had a non-significant lower risk for major adverse coronary and cerebrovascular events (MACCE) (log-rank: 4.905, P?=?.086). Cox regression analysis showed that T2 and T3 were inversely associated with major bleeding (hazard ratio [HR]:0.39, P?=?.050 and HR: 0.21, P?=?.005). Continuous TTR was inversely associated with major bleeding (HR: 0.98, P? < ?.001). For MACCE, adjusted Cox analysis found a non-significant lower risk for T3 (HR: 0.64, P?=?.128). Conclusions In AF patients undergoing PCI-S prescribed TAT, good quality anticoagulation control (as reflected by TTR) was closely related to bleeding outcomes during follow-up. Despite some suggestive trends for an inverse relationship between TTR and MACCE, no definitive conclusions can be drawn, and further large studies are needed.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Airaksinen","given":"K.E.J. Juhani","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rubboli","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schlitt","given":"Axel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kiviniemi","given":"Tuomas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Karjalainen","given":"Pasi P.P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory YH G.Y.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American Heart Journal","id":"ITEM-1","issued":{"date-parts":[["2017","8"]]},"page":"86-93","title":"Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry","type":"article-journal","volume":"190"},"uris":["",""]}],"mendeley":{"formattedCitation":"⁴⁹","plainTextFormattedCitation":"49","previouslyFormattedCitation":"⁴⁹"},"properties":{"noteIndex":0},"schema":""}49. The 2018 joint European consensus document underlined the need to shorten triple antithrombotic therapy in AF patients as much as possible, related to clinical presentation, bleeding risk, etcADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1093/europace/euy174","ISSN":"1532-2092","PMID":"30052888","abstract":"In 2014, a joint consensus document dealing with the management of antithrombotic therapy in atrial fibrillation (AF) patients presenting with acute coronary syndrome (ACS) and/or undergoing percutaneous coronary or valve interventions was published, which represented an effort of the European Society of Cardiology Working Group on Thrombosis, European Heart Rhythm Association (EHRA), European Association of Percutaneous Cardiovascular Interventions (EAPCI), and European Association of Acute Cardiac Care (ACCA) endorsed by the Heart Rhythm Society (HRS) and Asia-Pacific Heart Rhythm Society (APHRS). Since publication of this document, additional data from observational cohorts, randomized controlled trials, and percutaneous interventions as well as new guidelines have been published. Moreover, new drugs and devices/interventions are also available, with an increasing evidence base. The approach to managing AF has also evolved towards a more integrated or holistic approach. In recognizing these advances since the last consensus document, EHRA, WG Thrombosis, EAPCI, and ACCA, with additional contributions from HRS, APHRS, Latin America Heart Rhythm Society (LAHRS), and Cardiac Arrhythmia Society of Southern Africa (CASSA), proposed a focused update, to include the new data, with the remit of comprehensively reviewing the available evidence and publishing a focused update consensus document on the management of antithrombotic therapy in AF patients presenting with ACS and/or undergoing percutaneous coronary or valve interventions, and providing up-to-date consensus recommendations for use in clinical practice.","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Collet","given":"Jean-Phillippe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haude","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Byrne","given":"Robert","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chung","given":"Eugene H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fauchier","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Halvorsen","given":"Sigrun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lau","given":"Dennis","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lopez-Cabanillas","given":"Nestor","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lettino","given":"Maddalena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Marin","given":"Francisco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Obel","given":"Israel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rubboli","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Storey","given":"Robert F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Valgimigli","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Huber","given":"Kurt","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"ESC Scientific Document Group","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology","id":"ITEM-1","issued":{"date-parts":[["2018","7"]]},"title":"2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the Europ","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"⁵⁰","plainTextFormattedCitation":"50","previouslyFormattedCitation":"⁵⁰"},"properties":{"noteIndex":0},"schema":""}50. In this situation, a strategy based on NOACs was associated with a reduced risk of major bleeding eventsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1056/NEJMoa1611594","ISBN":"2012001491","ISSN":"0028-4793","PMID":"27959713","abstract":"BackgroundIn patients with atrial fibrillation undergoing percutaneous coronary intervention (PCI) with placement of stents, standard anticoagulation with a vitamin K antagonist plus dual antiplatelet therapy (DAPT) with a P2Y12 inhibitor and aspirin reduces the risk of thrombosis and stroke but increases the risk of bleeding. The effectiveness and safety of anticoagulation with rivaroxaban plus either one or two antiplatelet agents are uncertain. MethodsWe randomly assigned 2124 participants with nonvalvular atrial fibrillation who had undergone PCI with stenting to receive, in a 1:1:1 ratio, low-dose rivaroxaban (15 mg once daily) plus a P2Y12 inhibitor for 12 months (group 1), very-low-dose rivaroxaban (2.5 mg twice daily) plus DAPT for 1, 6, or 12 months (group 2), or standard therapy with a dose-adjusted vitamin K antagonist (once daily) plus DAPT for 1, 6, or 12 months (group 3). The primary safety outcome was clinically significant bleeding (a composite of major bleeding or minor bleeding according...","author":[{"dropping-particle":"","family":"Gibson","given":"C. Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mehran","given":"Roxana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bode","given":"Christoph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Halperin","given":"Jonathan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verheugt","given":"Freek W.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wildgoose","given":"Peter","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Birmingham","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ianus","given":"Juliana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Burton","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Eickels","given":"Martin","non-dropping-particle":"van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Korjian","given":"Serge","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Daaboul","given":"Yazan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cohen","given":"Marc","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Husted","given":"Steen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Peterson","given":"Eric D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fox","given":"Keith A.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"New England Journal of Medicine","id":"ITEM-1","issue":"25","issued":{"date-parts":[["2016"]]},"page":"2423-2434","title":"Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI","type":"article-journal","volume":"375"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1056/NEJMoa1708454","ISSN":"1533-4406","PMID":"28844193","abstract":"Background Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. Methods In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization. Results The incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; P<0.001 for noninferiority; P<0.001 for superiority) and 20.2% in the 150-mg dual-therapy group as compared with 25.7% in the corresponding triple-therapy group, which did not include elderly patients outside the United States (hazard ratio, 0.72; 95% CI, 0.58 to 0.88; P<0.001 for noninferiority). The incidence of the composite efficacy end point was 13.7% in the two dual-therapy groups combined as compared with 13.4% in the triple-therapy group (hazard ratio, 1.04; 95% CI, 0.84 to 1.29; P=0.005 for noninferiority). The rate of serious adverse events did not differ significantly among the groups. Conclusions Among patients with atrial fibrillation who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. (Funded by Boehring…","author":[{"dropping-particle":"","family":"Cannon","given":"Christopher P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bhatt","given":"Deepak L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oldgren","given":"Jonas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ellis","given":"Stephen G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kimura","given":"Takeshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maeng","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Merkely","given":"Bela","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zeymer","given":"Uwe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gropper","given":"Savion","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nordaby","given":"Matias","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kleine","given":"Eva","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Harper","given":"Ruth","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Manassie","given":"Jenny","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Januzzi","given":"James L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Berg","given":"Jurrien M","non-dropping-particle":"Ten","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Steg","given":"P Gabriel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hohnloser","given":"Stefan H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"RE-DUAL PCI Steering Committee and Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The New England journal of medicine","id":"ITEM-2","issued":{"date-parts":[["2017","8"]]},"page":"NEJMoa1708454","title":"Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"^51,52","plainTextFormattedCitation":"51,52","previouslyFormattedCitation":"^51,52"},"properties":{"noteIndex":0},"schema":""}51,52. However, a network meta-analysis concluded that the best treatment strategy for these high-risk patients still appears to be the use of a VKA and single antiplatelet drugs when considering both efficacy and safety, even though the use of low-dose rivaroxaban appears as a valid alternativeADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1371/journal.pone.0186449","ISSN":"1932-6203","PMID":"29023526","abstract":"OBJECTIVE The aim of this systematic review and network meta-analysis was to evaluate the comparative efficacy and safety of antiplatelet agents, vitamin K antagonist (VKA) and non-VKA oral anticoagulants (NOACs) in patients with atrial fibrillation (AF) undergoing percutaneous coronary intervention (PCI). METHODS PubMed, EMBASE, and the Cochrane Central Register of Controlled Trials were searched to identify clinical trials comparing antiplatelet drugs with VKA and NOACs or their combination in AF patients undergoing PCI with a mean/median follow-up of at least 12 months. A network meta-analysis was conducted to directly and indirectly compare the efficacy and safety of competitive antithrombotic regimens with a Bayesian random-effects model. Results were presented as relative risks (RRs) and 95% confidence intervals (CIs). RESULTS A total of 15 studies enrolling 13,104 patients were included. Among 5 regimens, rivaroxaban 15 mg daily plus P2Y12 inhibitor treatment demonstrated significant superiority over dual- and triple-antiplatelet therapies (DAPT, TT) in reducing thromboembolic events (0.64 [0.38, 0.95] and 0.68 [0.43, 0.98], respectively) but showed the maximum possibility of major bleeding risk, while VKA plus single antiplatelet therapy (SAPT) seemed the safest. Significantly less risk of major bleeding was seen in DAPT group than that in TT group (0.63 [0.39, 0.99]). CONCLUSIONS The present study suggests that combination of VKA and SAPT is the best choice for AF patients undergoing PCI considering both efficacy and safety. Rivaroxaban 2.5 mg twice daily plus DAPT treatment owns the highest probability to be the optimal alternative to VKA plus SAPT for these patients.","author":[{"dropping-particle":"","family":"Gong","given":"Xiaoxuan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tang","given":"Shaowen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Li","given":"Jiangjin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Xiwen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tian","given":"Xiaoyi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ma","given":"Shuren","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"PloS one","editor":[{"dropping-particle":"","family":"Pizzi","given":"Carmine","non-dropping-particle":"","parse-names":false,"suffix":""}],"id":"ITEM-1","issue":"10","issued":{"date-parts":[["2017","10"]]},"page":"e0186449","title":"Antithrombotic therapy strategies for atrial fibrillation patients undergoing percutaneous coronary intervention: A systematic review and network meta-analysis.","type":"article-journal","volume":"12"},"uris":["",""]}],"mendeley":{"formattedCitation":"⁵³","plainTextFormattedCitation":"53","previouslyFormattedCitation":"⁵³"},"properties":{"noteIndex":0},"schema":""}53. Nevertheless, this network meta-analysis did not include data from the RE-DUAL PCI trialADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1056/NEJMoa1708454","ISSN":"1533-4406","PMID":"28844193","abstract":"Background Triple antithrombotic therapy with warfarin plus two antiplatelet agents is the standard of care after percutaneous coronary intervention (PCI) for patients with atrial fibrillation, but this therapy is associated with a high risk of bleeding. Methods In this multicenter trial, we randomly assigned 2725 patients with atrial fibrillation who had undergone PCI to triple therapy with warfarin plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and aspirin (for 1 to 3 months) (triple-therapy group) or dual therapy with dabigatran (110 mg or 150 mg twice daily) plus a P2Y12 inhibitor (clopidogrel or ticagrelor) and no aspirin (110-mg and 150-mg dual-therapy groups). Outside the United States, elderly patients (≥80 years of age; ≥70 years of age in Japan) were randomly assigned to the 110-mg dual-therapy group or the triple-therapy group. The primary end point was a major or clinically relevant nonmajor bleeding event during follow-up (mean follow-up, 14 months). The trial also tested for the noninferiority of dual therapy with dabigatran (both doses combined) to triple therapy with warfarin with respect to the incidence of a composite efficacy end point of thromboembolic events (myocardial infarction, stroke, or systemic embolism), death, or unplanned revascularization. Results The incidence of the primary end point was 15.4% in the 110-mg dual-therapy group as compared with 26.9% in the triple-therapy group (hazard ratio, 0.52; 95% confidence interval [CI], 0.42 to 0.63; P<0.001 for noninferiority; P<0.001 for superiority) and 20.2% in the 150-mg dual-therapy group as compared with 25.7% in the corresponding triple-therapy group, which did not include elderly patients outside the United States (hazard ratio, 0.72; 95% CI, 0.58 to 0.88; P<0.001 for noninferiority). The incidence of the composite efficacy end point was 13.7% in the two dual-therapy groups combined as compared with 13.4% in the triple-therapy group (hazard ratio, 1.04; 95% CI, 0.84 to 1.29; P=0.005 for noninferiority). The rate of serious adverse events did not differ significantly among the groups. Conclusions Among patients with atrial fibrillation who had undergone PCI, the risk of bleeding was lower among those who received dual therapy with dabigatran and a P2Y12 inhibitor than among those who received triple therapy with warfarin, a P2Y12 inhibitor, and aspirin. Dual therapy was noninferior to triple therapy with respect to the risk of thromboembolic events. (Funded by Boehring…","author":[{"dropping-particle":"","family":"Cannon","given":"Christopher P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bhatt","given":"Deepak L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oldgren","given":"Jonas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ellis","given":"Stephen G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kimura","given":"Takeshi","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maeng","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Merkely","given":"Bela","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zeymer","given":"Uwe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gropper","given":"Savion","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nordaby","given":"Matias","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kleine","given":"Eva","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Harper","given":"Ruth","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Manassie","given":"Jenny","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Januzzi","given":"James L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Berg","given":"Jurrien M","non-dropping-particle":"Ten","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Steg","given":"P Gabriel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hohnloser","given":"Stefan H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"RE-DUAL PCI Steering Committee and Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The New England journal of medicine","id":"ITEM-1","issued":{"date-parts":[["2017","8"]]},"page":"NEJMoa1708454","title":"Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation.","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"⁵²","plainTextFormattedCitation":"52","previouslyFormattedCitation":"⁵²"},"properties":{"noteIndex":0},"schema":""}52. Future results from other ongoing trials (AUGUSTUS : NCT02415400; ENTRUST-AF-PCI : NCT02866175) will provide further evidence.In the clinical scenarios of catheter ablation and cardioversion procedures, the guidelines reviewed shared similar approaches regarding the use of OAC and NOACs. Several studies have examined the use of uninterrupted NOACs in the catheter ablation setting and all data support better safety profile compared to VKAs, with no differences in terms of efficacyADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1111/1755-5922.12457","ISSN":"17555914","PMID":"29971964","abstract":"AIMS Catheter ablation for atrial fibrillation (AF) is associated with a transitory increase in the risk of both thromboembolic and bleeding events. Evidence on the use of nonvitamin K antagonist oral anticoagulants (NOACs) in patients undergoing AF ablation mostly comes from small observational studies, underpowered to detect differences in clinical outcomes between NOACs and vitamin K antagonists (VKAs) treated patients. This updated meta-analysis aimed to determine the safety and efficacy of periprocedural anticoagulation with NOACs compared with VKAs in AF patients undergoing catheter ablation. METHODS We searched MEDLINE, Cochrane library, and web sources for randomized and observational studies comparing periprocedural treatment with NOACs and VKAs in patients undergoing AF ablation. The primary safety endpoint was major bleeding events, and the primary efficacy endpoint was thromboembolic events (a composite of systemic thromboembolism, transient ischemic attack, and stroke). RESULTS A total of 29 studies with 12?644 patients were included in the meta-analysis. Overall, patients on NOACs had a significantly lower risk of major bleeding compared to VKAs either in observational studies (Peto OR 0.68; 95% CI: 0.48-0.95; P?=?0.022; I2 ?=?20%) or in RCTs (Peto OR 0.30; 95% CI: 0.14-0.62; P?=?0.001; I2 ?=?28%). Uninterrupted NOACs reduced the risk of major bleeding when compared to uninterrupted VKAs (Peto OR 0.66; 95% CI: 0.45-0.96; P?=?0.028; I2 ?=?1%), similarly, interrupted NOACs lowered the risk of major bleeding compared to interrupted VKAs (Peto OR 0.29; 95% CI: 0.13-0.66; P?=?0.003; I2 ?=?0%; Pinteraction ?=?0.076). The rate of thromboembolic complications was very low and did not significantly differ between the study groups either in observational studies (Peto OR 0.91; 95% CI: 0.49-1.67; P?=?0.755; I2 ?=?0%) or in RCTs (Peto OR 0.14; 95% CI: 0.01-1.30; P?=?0.083; I2 ?=?0%). CONCLUSIONS Use of NOACs compared to VKAs significantly reduced the risk of bleeding in patients with AF ablation. Similarly, the risk of bleeding was lower with uninterrupted NOACs than with uninterrupted VKAs, and with interrupted NOACs than with interrupted VKAs. The rate of thromboembolic complications was extremely low in both study groups without any differences.","author":[{"dropping-particle":"","family":"Ge","given":"Zhen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Faggioni","given":"Michela","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Baber","given":"Usman","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sartori","given":"Samantha","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sorrentino","given":"Sabato","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farhan","given":"Serdar","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chandrasekhar","given":"Jaya","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vogel","given":"Birgit","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qadeer","given":"Abdul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Halperin","given":"Jonathan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Reddy","given":"Vivek","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dukkipati","given":"Srinivas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dangas","given":"George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mehran","given":"Roxana","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Cardiovascular Therapeutics","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","10"]]},"page":"e12457","title":"Safety and efficacy of nonvitamin K antagonist oral anticoagulants during catheter ablation of atrial fibrillation: A systematic review and meta-analysis","type":"article-journal","volume":"36"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.ijcard.2018.06.024","ISSN":"01675273","PMID":"29903520","abstract":"BACKGROUND In patients undergoing atrial fibrillation (AF) ablation, despite uninterrupted oral anticoagulants (OACs) have been recommended, no consensus has emerged regarding to whether uninterrupted novel oral anticoagulants (NOACs) are superior to uninterrupted vitamin K antagonists (VKAs) for the periprocedural antithrombotic management. This meta-analysis aimed to compare the efficacy and safety of uninterrupted NOACs and uninterrupted VKAs in patients undergoing AF ablation. METHODS Databases were searched for articles published up to March 20, 2018. Only randomized controlled trials (RCTs) were selected. The data were analyzed with RevMan 5.3 using a fixed-effects method. RESULTS 6 RCTs and 1903 patients were included. There was no significant difference between NOACs group and VKAs group in incidence of stroke or TIA (OR?=?1.00, 95% CI?=?0.23-4.40, P?=?1.00), silent cerebral thromboembolic events (OR?=?1.09, 95% CI?=?0.67-1.75, P?=?0.74) or minor bleeding (OR?=?1.01, 95% CI?=?0.78-1.31, P?=?0.93), which were consistent in subgroup analysis of individual NOAC vs. VKAs group. NOACs treatment was associated with reduced risk of major bleeding as compared with VKAs (OR?=?0.45, 95% CI?=?0.26-0.81, P?<?0.01). In the subgroup analyses, only the dabigatran group showed significant lower incidence of major bleeding compared to VKAs group. CONCLUSIONS In patients undergoing AF ablation, uninterrupted NOACs is as effective as uninterrupted VKAs treatment, uninterrupted dabigatran (150?mg twice daily) may be superior to other uninterrupted OACs strategies.","author":[{"dropping-particle":"","family":"Zhao","given":"Yating","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lu","given":"Yao","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Qin","given":"Yue","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"International Journal of Cardiology","id":"ITEM-2","issued":{"date-parts":[["2018","11"]]},"page":"167-171","title":"A meta-analysis of randomized controlled trials of uninterrupted periprocedural anticoagulation strategy in patients undergoing atrial fibrillation catheter ablation","type":"article-journal","volume":"270"},"uris":["",""]}],"mendeley":{"formattedCitation":"^54,55","plainTextFormattedCitation":"54,55","previouslyFormattedCitation":"^54,55"},"properties":{"noteIndex":0},"schema":""}54,55. In the cardioversion setting NOACs were similar to VKAs in terms of both efficacy and safetyADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1007/s11239-018-1622-5","ISSN":"0929-5305","PMID":"29404874","abstract":"Pharmacological or electrical cardioversion allows immediate symptoms improvement in the setting of paroxysmal or persistent atrial fibrillation (AF), although the periprocedural risk of systemic embolism should be considered. Recently, there was a great interest on the safety and efficacy of direct oral anticoagulants (DOACs) when used for the cardioversion of non-valvular AF. We performed a random-effects meta-analysis of patients undergoing both electrical and pharmacologic cardioversion for non-valvular AF in the RE-LY, ROCKET-AF, ARISTOTLE, ENGAGE AF-TIMI 48, X-VeRT, ENSURE-AF, and EMANATE trials. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% confidence intervals (CIs) for stroke/systemic embolism (SSE) and major bleeding (MB) at follow-up. A total of 8564 patients have been included in the analysis. When compared with patients receiving vitamin-K antagonists (VKAs), patients receiving DOACs had a lower risk of SSE (RR 0.70, 95% CI 0.33-1.546, P?=?0.34), as well as of MB (RR 0.86;,95% CI 0.47-1.58, P?=?0.62), although both were non-significant. Funnel plot analysis showed, however, lower RRs with more recent ad hoc studies in comparison with registrational studies, even though statistical significance?was not reached. DOACs are as effective and as safe as VKAs for thromboembolic prevention in non-valvular AF in the setting of cardioversion. There are differences, although non-significant, between registrational studies and studies enrolling exclusively patients undergoing cardioversion of AF.","author":[{"dropping-particle":"","family":"Brunetti","given":"Natale Daniele","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tarantino","given":"Nicola","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gennaro","given":"Luisa","non-dropping-particle":"De","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Correale","given":"Michele","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Santoro","given":"Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Biase","given":"Matteo","non-dropping-particle":"Di","parse-names":false,"suffix":""}],"container-title":"Journal of Thrombosis and Thrombolysis","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2018","5"]]},"page":"550-556","title":"Direct oral anti-coagulants compared to vitamin-K antagonists in cardioversion of atrial fibrillation: an updated meta-analysis","type":"article-journal","volume":"45"},"uris":["",""]}],"mendeley":{"formattedCitation":"⁵⁶","plainTextFormattedCitation":"56","previouslyFormattedCitation":"⁵⁶"},"properties":{"noteIndex":0},"schema":""}56.With regard to specific populations (patients with chronic kidney disease, the elderly and frail, patients with AHREs), the guidelines highlight the absence of specific controlled studies exploring the efficacy and safety of OAC and NOACs in these populations. Even though observational data are available and subgroups analysis provided some evidence to draft some recommendations, this evidence was not considered solid enough to provide strong recommendations. Future studies are still needed in patients with chronic kidney disease and those elderly and frail to better substantiate current clinical practice. Regarding patients with AHREs, some studies are currently in progress and will elucidate the risk-benefit ratio of treating these patients with OACADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.ahj.2017.04.008","ISSN":"1097-6744","PMID":"28625370","abstract":"BACKGROUND Device-detected subclinical atrial fibrillation (AF) refers to infrequent, short-lasting, asymptomatic AF that is detected only with long-term continuous monitoring. Subclinical AF is common and associated with an increased risk of stroke; however, the risk of stroke with subclinical AF is lower than for clinical AF, and very few patients with subclinical AF alone have been included in large AF anticoagulation trials. The net benefit of anticoagulation in patients with subclinical AF is unknown. DESIGN ARTESiA is a prospective, multicenter, double-blind, randomized controlled trial, recruiting patients with subclinical AF detected by an implanted pacemaker, defibrillator, or cardiac monitor, and who have additional risk factors for stroke. Patients with clinical AF documented by surface electrocardiogram will be excluded from the study. Participants will be randomized to receive either apixaban (according to standard AF dosing) or aspirin 81mg daily. The primary outcome is the composite of stroke, transient ischemic attack with diffusion-weighted magnetic resonance imaging evidence of cerebral infarction, and systemic embolism. Approximately 4,000 patients will be enrolled from around 230 clinical sites, with an anticipated mean follow-up of 36months until 248 adjudicated primary outcome events have occurred. SUMMARY ARTESiA will determine whether oral anticoagulation therapy with apixaban compared with aspirin reduces the risk of stroke or systemic embolism in patients with subclinical AF and additional risk factors.","author":[{"dropping-particle":"","family":"Lopes","given":"Renato D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Alings","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Beresh","given":"Heather","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Granger","given":"Christopher B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mazuecos","given":"Juan Benezet","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nielsen","given":"Jens C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Conen","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hohnloser","given":"Stefan H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mairesse","given":"Georges H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mabo","given":"Philippe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeffrey S","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American heart journal","id":"ITEM-1","issued":{"date-parts":[["2017","7"]]},"page":"137-145","title":"Rationale and design of the Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESiA) trial.","type":"article-journal","volume":"189"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.ahj.2017.04.015","ISSN":"1097-6744","PMID":"28760205","abstract":"Oral anticoagulation prevents ischemic strokes in patients with atrial fibrillation (AF). Early detection of AF and subsequent initiation of oral anticoagulation help to prevent strokes in AF patients. Implanted cardiac pacemakers and defibrillators allow seamless detection of atrial high rate episodes (AHRE), but the best antithrombotic therapy in patients with AHRE is not known. RATIONALE Stroke risk is higher in pacemaker patients with AHRE than in those without, but the available data also show that stroke risk in patients with AHRE is lower than in patients with AF. Furthermore, only a minority of patients with AHRE will develop AF, many strokes occur without a temporal relation to AHRE, and AHRE can reflect other arrhythmias than AF or artifacts. An adequately powered controlled trial of oral anticoagulation in patients with AHRE is needed. DESIGN The Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6 ) trial tests whether oral anticoagulation with edoxaban is superior to prevent the primary efficacy outcome of stroke or cardiovascular death compared with aspirin or no antithrombotic therapy based on evidence-based indications. The primary safety outcome will be major bleeding. NOAH-AFNET 6 will randomize 3,400 patients with AHRE, but without documented AF, aged ≥65 years with at least 1 other stroke risk factor, to oral anticoagulation therapy (edoxaban) or no anticoagulation. All patients will be followed until the end of this investigator-driven, prospective, parallel-group, randomized, event-driven, double-blind, multicenter phase IIIb trial. Patients will be censored when they develop AF and offered open-label anticoagulation. The sponsor is the Atrial Fibrillation NETwork (AFNET). The trial is supported by the DZHK (German Centre for Cardiovascular Research), the BMBF (German Ministry of Education and Research), and Daiichi Sankyo Europe. CONCLUSION NOAH-AFNET 6 will provide robust information on the effect of oral anticoagulation in patients with atrial high rate episodes detected by implanted devices.","author":[{"dropping-particle":"","family":"Kirchhof","given":"Paulus","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Blank","given":"Benjamin F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Calvert","given":"Melanie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chlouverakis","given":"Gregory","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Diener","given":"Hans-Christoph","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goette","given":"Andreas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Huening","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Simantirakis","given":"Emmanuel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vardas","given":"Panos","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"American heart journal","id":"ITEM-2","issued":{"date-parts":[["2017","8"]]},"page":"12-18","title":"Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial.","type":"article-journal","volume":"190"},"uris":["",""]}],"mendeley":{"formattedCitation":"^57,58","plainTextFormattedCitation":"57,58","previouslyFormattedCitation":"^57,58"},"properties":{"noteIndex":0},"schema":""}57,58.In some of the contemporary guidelines, the need for integrated management for AF patients is highlighted. On the basis of the evidence that AF patients are burdened with an increased risk of major adverse outcomes beyond their mere thromboembolic risksADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1161/CIRCULATIONAHA.114.014145","ISSN":"1524-4539","PMID":"25918127","abstract":"BACKGROUND: It has recently been reported that atrial fibrillation (AF) is associated with an increased risk of myocardial infarction (MI). However, the mechanism underlying this association is currently unknown. Further study of the relationship of AF with the type of MI (ST-segment-elevation MI [STEMI] versus non-ST-segment-elevation MI [NSTEMI]) might shed light on the potential mechanisms.\n\nMETHODS AND RESULTS: We examined the association between AF and incident MI in 14?462 participants (mean age, 54 years; 56% women; 26% blacks) from the Atherosclerosis Risk in Communities (ARIC) study who were free of coronary heart disease at baseline (1987-1989) with follow-up through December 31, 2010. AF cases were identified from study visit ECGs and by review of hospital discharge records. Incident MI and its types were ascertained by an independent adjudication committee. Over a median follow-up of 21.6 years, 1374 MI events occurred (829 NSTEMIs, 249 STEMIs, 296 unclassifiable MIs). In a multivariable-adjusted model, AF (n=1545) as a time-varying variable was associated with a 63% increased risk of MI (hazard ratio,1.63; 95% confidence interval, 1.32-2.02). However, AF was associated with NSTEMI (hazard ratio, 1.80; 95% confidence interval, 1.39-2.31) but not STEMI (hazard ratio, 0.49; 95% confidence interval, 0.18-1.34; P for hazard ratio comparison=0.004). Combining the unclassifiable MI group with either STEMI or NSTEMI did not change this conclusion. The association between AF and MI, total and NSTEMI, was stronger in women than in men (P for interaction <0.01 for both).\n\nCONCLUSIONS: AF is associated with an increased risk of incident MI, especially in women. However, this association is limited to NSTEMI.","author":[{"dropping-particle":"","family":"Soliman","given":"Elsayed Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lopez","given":"Faye","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"O'Neal","given":"Wesley T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chen","given":"Lin Y","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bengtson","given":"Lindsay","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Zhu-Ming","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Loehr","given":"Laura","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cushman","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Alonso","given":"Alvaro","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Circulation","id":"ITEM-1","issue":"21","issued":{"date-parts":[["2015","5"]]},"page":"1843-50","title":"Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study.","type":"article-journal","volume":"131"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/europace/euw112","ISSN":"1532-2092","PMID":"27194538","abstract":"Aims Atrial fibrillation (AF) is commonly associated with a high risk of stroke, thromboembolism, and mortality. The 1-year follow-up of the EURObservational Research Programme-Atrial Fibrillation (EORP-AF) Pilot Registry demonstrated a high mortality but good outcomes with European Society of Cardiology guideline-adherent therapy. Whether these 'real-world' observations on patients managed by European cardiologists extend to 2 years remains uncertain. Methods and results In this report from the EORP-AF General Registry Pilot Phase, we provide data on the 2-year follow-up outcomes. Consistent with the 1-year follow-up report, only a small proportion of patients were symptomatic (24.9%), with minor differences between the different AF subtypes. Persistence of oral anticoagulant (OAC) therapy remains high at 2-years, with ～80% of patients treated with OAC. The prescribing rates of non-vitamin K antagonist oral anticoagulants are progressively increasing (13.7% at 2 years). Rate and rhythm control approaches remained consistent across the entire follow-up observation. Overall mortality rates remained high, with 5.0% of patients dead during the 2-year follow-up, mostly due to cardiovascular causes (61.8%). Atrial fibrillation readmissions were frequent, particularly related to arrhythmias and heart failure. On multivariate analyses, any cardiovascular reason for admission rather than AF was significantly associated with increased mortality during the 2-year follow-up. Conclusion In this 2-year follow-up report from EORP-AF, mortality rates with AF remain high from cardiovascular causes, despite the high prevalent use of OAC. Improved management strategies to reduce major adverse outcomes in AF patients are needed.","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"Cécile","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Opolski","given":"Grzegorz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"Aldo P","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"AF Gen Pilot Investigators","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Europace","id":"ITEM-2","issue":"5","issued":{"date-parts":[["2017","5"]]},"page":"722-733","title":"'Real-world' atrial fibrillation management in Europe: observations from the 2-year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase.","type":"article-journal","volume":"19"},"uris":["","",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1016/j.ejim.2018.05.016","ISSN":"18790828","abstract":"? 2018 European Federation of Internal Medicine Background: In 2002, the European Society of Cardiology conducted the Euro Heart Survey (EHS), while in 2014concluded 1-year follow-up of the EURObservational Research Programme AF (EORP-AF) Pilot Registry. Methods: We analysed differences in clinical profiles, therapeutic approaches and outcomes between these two cohorts after propensity score matching (PSM). Results: After PSM, 5206 patients were analysed. In EORP-AF there were more elderly patients than EHS (p < .001). EORP-AF patients were more burdened with cardiovascular (CV) and non-CV comorbidities, with a higher proportion of patients with high thromboembolic risk. EORP-AF patients used more oral-anticoagulant (OAC) (p < .001). At 1-year follow-up EORP-AF patients had lower risk for thromboembolic and CV events, readmission for AF and other CV reasons (all p < .001), showing conversely a higher risk for CV death (p =.015). Kaplan-Meier curves showed that EORP-AF patients had higher risk for CV death (p < .0001) and all-cause death (p =.0019). Cox regression confirmed that EORP-AF patients were at higher risk for CV death (p =.021). Conclusions: We found significant changes in AF epidemiology over a decade in Europe, with older patients, more burdened with comorbidities. A greater use of OAC was found. Despite a reduction in risk for thromboembolic events, a high risk of CV-related death was still evident.","author":[{"dropping-particle":"","family":"Proietti","given":"M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Laroche","given":"C.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nieuwlaat","given":"R.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crijns","given":"H.J.G.M.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maggioni","given":"A.P.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"D.A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"G.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G.Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"European Journal of Internal Medicine","id":"ITEM-3","issued":{"date-parts":[["2018"]]},"title":"Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries","type":"article-journal"},"uris":["","",""]},{"id":"ITEM-4","itemData":{"DOI":"10.1001/jamainternmed.2013.11912","ISSN":"2168-6114","PMID":"24190540","abstract":"IMPORTANCE: Myocardial infarction (MI) is an established risk factor for atrial fibrillation (AF). However, the extent to which AF is a risk factor for MI has not been investigated.\n\nOBJECTIVE: To examine the risk of incident MI associated with AF.\n\nDESIGN, SETTING, AND PARTICIPANTS: A prospective cohort of 23,928 participants residing in the continental United States and without coronary heart disease at baseline were enrolled from the Reasons for Geographic and Racial Differences in Stroke (REGARDS) cohort between 2003 and 2007, with follow-up through December 2009.\n\nMAIN OUTCOMES AND MEASURES: Expert-adjudicated total MI events (fatal and nonfatal).\n\nRESULTS: Over 6.9 years of follow-up (median 4.5 years), 648 incident MI events occurred. In a sociodemographic-adjusted model, AF was associated with about 2-fold increased risk of MI (hazard ratio [HR], 1.96 [95% CI, 1.52-2.52]). This association remained significant (HR, 1.70 [95% CI, 1.26-2.30]) after further adjustment for total cholesterol, high-density lipoprotein cholesterol, smoking status, systolic blood pressure, blood pressure-lowering drugs, body mass index, diabetes, warfarin use, aspirin use, statin use, history of stroke and vascular disease, estimated glomerular filtration rate, albumin to creatinine ratio, and C-reactive protein level. In subgroup analysis, the risk of MI associated with AF was significantly higher in women (HR, 2.16 [95% CI, 1.41-3.31]) than in men (HR, 1.39 [95% CI, 0.91-2.10]) and in blacks (HR, 2.53 [95% CI, 1.67-3.86]) than in whites (HR, 1.26 [95% CI, 0.83-1.93]); for interactions, P = .03 and P = .02, respectively. On the other hand, there were no significant differences in the risk of MI associated with AF in older (≥75 years) vs younger (<75 years) participants (HR, 2.00 [95% CI, 1.16-3.35] and HR, 1.60 [95% CI, 1.11-2.30], respectively); for interaction, P = .44.\n\nCONCLUSIONS AND RELEVANCE: AF is independently associated with an increased risk of incident MI, especially in women and blacks. These findings add to the growing concerns of the seriousness of AF as a public health burden: in addition to being a well-known risk factor for stroke, AF is also associated with increased risk of MI.","author":[{"dropping-particle":"","family":"Soliman","given":"Elsayed Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Safford","given":"Monika M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Muntner","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Khodneva","given":"Yulia","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dawood","given":"Farah Z","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zakai","given":"Neil A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thacker","given":"Evan L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Judd","given":"Suzanne","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howard","given":"Virginia J","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Howard","given":"George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Herrington","given":"David M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cushman","given":"Mary","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"JAMA internal medicine","id":"ITEM-4","issue":"1","issued":{"date-parts":[["2014","1"]]},"page":"107-14","title":"Atrial fibrillation and the risk of myocardial infarction.","type":"article-journal","volume":"174"},"uris":[""]}],"mendeley":{"formattedCitation":"^9,10,24,25","plainTextFormattedCitation":"9,10,24,25","previouslyFormattedCitation":"^9,10,24,25"},"properties":{"noteIndex":0},"schema":""}9,10,24,25, an approach that would account for the multiple issues related to the clinical management of these patients is neededADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/S0140-6736(17)31072-3","ISSN":"1474-547X","PMID":"28460828","abstract":"Atrial fibrillation is one of the major cardiovascular health problems: it is a common, chronic condition, affecting 2-3% of the population in Europe and the USA and requiring 1-3% of health-care expenditure as a result of stroke, sudden death, heart failure, unplanned hospital admissions, and other complications. Early diagnosis of atrial fibrillation, ideally before the first complication occurs, remains a challenge, as shown by patients who are only diagnosed with the condition when admitted to hospital for acute cardiac decompensation or stroke. Once diagnosed, atrial fibrillation requires chronic, multidimensional management in five domains (acute management, treatment of underlying and concomitant cardiovascular conditions, stroke prevention therapy, rate control, and rhythm control). The consistent provision of these treatment options to all patients with atrial fibrillation is difficult, despite recent improvements in organisation of care, knowledge about atrial fibrillation, and treatment options. Integrated care models that provide patient-centred care in, or close to, the patient's community while maintaining access to all specialist treatment options, emerge as the best approach to achieve consistent delivery of these chronic treatments to all patients with atrial fibrillation. Ongoing research efforts will establish when to initiate oral anticoagulation in patients with device-detected atrial high-rate episodes, quantify the prognostic effect of early and comprehensive rhythm control therapy, including atrial fibrillation ablation, and delineate optimum methods to reduce bleeding complications in patients treated with anticoagulation. Additionally, research efforts are needed to define different types of atrial fibrillation on the basis of the main causes of atrial fibrillation to pave the way for the clinical development of stratified atrial fibrillation therapy.","author":[{"dropping-particle":"","family":"Kirchhof","given":"Paulus","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Lancet (London, England)","id":"ITEM-1","issue":"10105","issued":{"date-parts":[["2017","10"]]},"page":"1873-1887","title":"The future of atrial fibrillation management: integrated care and stratified therapy.","type":"article-journal","volume":"390"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1093/europace/eux318","ISBN":"1532-2092 (Electronic) 1099-5129 (Linking)","ISSN":"15322092","PMID":"29300976","abstract":"There are major challenges ahead for clinicians treating patients with atrial fibrillation (AF). The population with AF is expected to expand considerably and yet, apart from anticoagulation, therapies used in AF have not been shown to consistently impact on mortality or reduce adverse cardiovascular events. New approaches to AF management, including the use of novel technologies and structured, integrated care, have the potential to enhance clinical phenotyping or result in better treatment selection and stratified therapy. Here, we report the outcomes of the 6th Consensus Conference of the Atrial Fibrillation Network (AFNET) and the European Heart Rhythm Association (EHRA), held at the European Society of Cardiology Heart House in Sophia Antipolis, France, 17-19 January 2017. Sixty-two global specialists in AF and 13 industry partners met to develop innovative solutions based on new approaches to screening and diagnosis, enhancing integration of AF care, developing clinical pathways for treating complex patients, improving stroke prevention strategies, and better patient selection for heart rate and rhythm control. Ultimately, these approaches can lead to better outcomes for patients with AF.","author":[{"dropping-particle":"","family":"Kotecha","given":"Dipak","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Breithardt","given":"Günter","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Camm","given":"A John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schotten","given":"Ulrich","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ahlsson","given":"Anders","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Arnar","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atar","given":"Dan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Auricchio","given":"Angelo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bax","given":"Jeroen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Benussi","given":"Stefano","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Blomstrom-Lundqvist","given":"Carina","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Borggrefe","given":"Martin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Brandes","given":"Axel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Calkins","given":"Hugh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Casadei","given":"Barbara","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Castellá","given":"Manuel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chua","given":"Winnie","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Crijns","given":"Harry","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dobrev","given":"Dobromir","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fabritz","given":"Larissa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Feuring","given":"Martin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gerth","given":"Andrea","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Goette","given":"Andreas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Guasch","given":"Eduard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haase","given":"Doreen","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hatem","given":"Stephane","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Haeusler","given":"Karl 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A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lewalter","given":"Thorsten","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mont","given":"Lluís","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nabauer","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nielsen","given":"Jens C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oeff","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oldgren","given":"Jonas","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Oto","given":"Ali","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pison","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Potpara","given":"Tatjana","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ravens","given":"Ursula","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Richard-Lordereau","given":"Isabelle","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rienstra","given":"Michiel","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Savelieva","given":"Irina","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Schnabel","given":"Renate","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sinner","given":"Moritz F","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sommer","given":"Philipp","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Themistoclakis","given":"Sakis","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gelder","given":"Isabelle C","non-dropping-particle":"Van","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Vardas","given":"Panagiotis E","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wakili","given":"Reza","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Weber","given":"Evelyn","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Willems","given":"Stephan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ziegler","given":"André","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hindricks","given":"Gerhard","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kirchhof","given":"Paulus","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Europace","id":"ITEM-2","issue":"3","issued":{"date-parts":[["2018","3"]]},"page":"395-407","title":"Integrating new approaches to atrial fibrillation management: The 6th AFNET/EHRA Consensus Conference","type":"article-journal","volume":"20"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^11,12","plainTextFormattedCitation":"11,12","previouslyFormattedCitation":"^11,12"},"properties":{"noteIndex":0},"schema":""}11,12. The 2016 ESC guidelines refer to the ‘domains of AF management’ and the need for a multidisciplinary approach to AF management (with so-called ‘Heart Team’) but the operationalisation of such an approach requires simple and practical approaches for the AF patient management pathway.Indeed, the use of an integrated management approach to AF is associated with a reduced risk of all-cause death, cardiovascular death and rehospitalizationADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1136/heartjnl-2016-310952","ISBN":"2016310952","ISSN":"1468201X","PMID":"28490616","abstract":"OBJECTIVE Atrial fibrillation (AF) is an emerging global epidemic associated with significant morbidity and mortality. Whilst other chronic cardiovascular conditions have demonstrated enhanced patient outcomes from coordinated systems of care, the use of this approach in AF is a comparatively new concept. Recent evidence has suggested that the integrated care approach may be of benefit in the AF population, yet has not been widely implemented in routine clinical practice. We sought to undertake a systematic review and meta-analysis to evaluate the impact of integrated care approaches to care delivery in the AF population on outcomes including mortality, hospitalisations, emergency department visits, cerebrovascular events and patient-reported outcomes. METHODS PubMed, Embase and CINAHL databases were searched until February 2016 to identify papers addressing the impact of integrated care in the AF population. Three studies, with a total study population of 1383, were identified that compared integrated care approaches with usual care in AF populations. RESULTS Use of this approach was associated with a reduction in all-cause mortality (OR 0.51, 95%?CI 0.32 to 0.80, p=0.003) and cardiovascular hospitalisations (OR 0.58, 95%?CI 0.44 to 0.77, p=0.0002) but did not significantly impact on AF-related hospitalisations (OR 0.82, 95%?CI 0.56 to 1.19, p=0.29) or cerebrovascular events (OR 1.00, 95%?CI 0.48 to 2.09, p=1.00). CONCLUSIONS The use of the integrated care approach in AF is associated with reduced cardiovascular hospitalisations and all-cause mortality. Further research is needed to identify optimal settings, methods and components of delivering integrated care to the burgeoning AF population.","author":[{"dropping-particle":"","family":"Gallagher","given":"Celine","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Elliott","given":"Adrian D.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wong","given":"Christopher X.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Rangnekar","given":"Geetanjali","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Middeldorp","given":"Melissa E.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mahajan","given":"Rajiv","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lau","given":"Dennis H.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sanders","given":"Prashanthan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Hendriks","given":"Jeroen M.L.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Heart","id":"ITEM-1","issue":"24","issued":{"date-parts":[["2017","5"]]},"page":"1947-1953","title":"Integrated care in atrial fibrillation: A systematic review and meta-analysis","type":"article-journal","volume":"103"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.amjmed.2018.06.012","ISSN":"00029343","PMID":"30153428","abstract":"BACKGROUND Integrated care for the clinical management of atrial fibrillation patients is advocated as a holistic way to improve outcomes; the simple Atrial fibrillation Better Care (ABC) pathway has been proposed. The ABC pathway streamlines care as follows: ‘A’ Avoid stroke; ‘B’ Better symptom management; ‘C’ Cardiovascular and Comorbidity optimization. METHODS We performed a post hoc analysis of the Atrial Fibrillation Follow-Up Investigation of Rhythm Management (AFFIRM) trial. An ‘integrated care’ approach was defined according to the ABC pathway. Patients fulfilling all criteria were categorized as the ‘ABC’ group; those not fulfilling all criteria were the ‘non-ABC’ group. Trial-adjudicated all-cause death, composite outcome of stroke/major bleeding/cardiovascular death, and first hospitalization were the main study outcomes. RESULTS Among the 4060 patients in the original cohort, 3169 (78%) had available data to compare integrated care (ABC; n = 222; 7%) vs non-ABC (n = 2947; 93%) management. Over a median follow-up of 3.7 (interquartile range, 2.8-4.6) years, atrial fibrillation patients managed with integrated care (ABC group) had lower rates for all study outcomes (all P < .001) compared with the non-ABC group. A Cox multivariable regression analysis showed that atrial fibrillation patients managed in the ABC group had a significantly lower risk of all-cause death (hazard ratio [HR], 0.35; 95% confidence interval [CI], 0.17-0.75), composite outcome (HR, 0.35; 95% CI, 0.18-0.68), and first hospitalization (HR, 0.65; 95% CI, 0.53-0.80). CONCLUSIONS The simple ABC pathway allows the streamlining of integrated care for atrial fibrillation patients in a holistic manner and is associated with a lower risk of adverse outcomes (including mortality, stroke/major bleeding/cardiovascular death, and hospitalization).","author":[{"dropping-particle":"","family":"Proietti","given":"Marco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Romiti","given":"Giulio Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Olshansky","given":"Brian","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A.","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The American Journal of Medicine","id":"ITEM-2","issued":{"date-parts":[["2018","8"]]},"title":"Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway","type":"article-journal"},"uris":["",""]}],"mendeley":{"formattedCitation":"^59,60","plainTextFormattedCitation":"59,60","previouslyFormattedCitation":"^59,60"},"properties":{"noteIndex":0},"schema":""}59,60 ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.mayocp.2018.10.022","ISSN":"00256196","PMID":"30551910","abstract":"OBJECTIVE To investigate the impact on cardiovascular events (CVEs) in a real-world population of patients with atrial fibrillation (AF) by implementing the Atrial fibrillation Better Care (ABC: A, Avoid stroke with anticoagulation; B, better symptom management; C, Cardiovascular and comorbidity risk management) pathway. PATIENTS AND METHODS This prospective single-center cohort study included 907 consecutive patients with nonvalvular AF on vitamin K antagonists from February 2008 to December 2016. The A, B, and C groups were defined as follows: \"A\" by a Time in Therapeutic Range ≥65%; \"B\" by a European Heart Rhythm Association (EHRA) symptom scale I-II, and \"C\" as optimized cardiovascular comorbidity management. Primary end point was a composite outcome of CVEs. RESULTS During a median follow-up of 36.9 months (interquartile range [IQR] 20.0-57.5; 3022 patient-years), 118 CVEs occurred (3.9% per year; 95% confidence interval [CI], 3.2-4.7). Symptomatic patients (EHRA III-IV) had a higher risk of CVEs compared with those in EHRA I (hazard ratio [HR], 2.73, 95% CI, 1.61-4.63, P<.001). Optimally managed patients in the ABC group (n=198) had a lower risk of CVEs (1.8 [95% CI, 0.9-3.0] vs 4.5% [95% CI, 3.7-5.5] per year, P=.001) compared with those presenting with at least 1 suboptimal ABC factor (HR, 0.40, 95% CI, 0.22-0.74, P=.003). This association was evident using multivariate Cox proportional regression analysis (HR, 0.44, 95% CI, 0.24-0.80, P=.007). CONCLUSION Integrated care management according to the ABC pathway resulted in a significantly lower rate of CVEs, suggesting a clear benefit of a holistic approach to optimize the management of patients with AF. TRIAL REGISTRATION Identifier: NCT01882114.","author":[{"dropping-particle":"","family":"Pastori","given":"Daniele","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pignatelli","given":"Pasquale","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Menichelli","given":"Danilo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Violi","given":"Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y.H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Mayo Clinic Proceedings","id":"ITEM-1","issued":{"date-parts":[["2018","12","11"]]},"title":"Integrated Care Management of Patients With Atrial Fibrillation and Risk of Cardiovascular Events","type":"article-journal"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶¹","plainTextFormattedCitation":"61","previouslyFormattedCitation":"⁶¹"},"properties":{"noteIndex":0},"schema":""}61. Compliance with the ABC pathway is also associated with reduced healthcare costsADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.amjmed.2019.01.003","ISSN":"00029343","abstract":"<h2>Abstract</h2><h3>BACKGROUND</h3><p>The Atrial fibrillation Better Care (ABC) pathway for the integrated approach to the management of patients with atrial fibrillation has been proposed to streamline patient management in an integrated, holistic manner, as follows: ‘A' Avoid stroke with Anticoagulation; ‘B' Better symptom management, with rate or rhythm control; ‘C' Cardiovascular risk and comorbidity management, including lifestyle factors. ABC pathway compliance has been associated with a reduced rate of cardiovascular events compared to non-ABC compliant patients. However, the impact of the ABC pathway on health-related costs has not been evaluated.</p><h3>METHODS</h3><p>We performed an exploratory analysis of costs related to cardiovascular events in the ATHERO-AF study, which is a prospective single-center cohort study including atrial fibrillation patients treated with vitamin K antagonists. A Diagnosis-Related Group code provided by the Italian Ministry of Health was assigned to each cardiovascular event by event typology to estimate the relative cost. The analysis was performed by dividing patients according to ABC pathway components.</p><h3>RESULTS</h3><p>Overall, the 118 cardiovascular events in the cohort incurred a cost of 1,017,354 euros (1,149,610 USD). The mean total costs were 13,050 (14,747 USD) and 11,218 euros (12,676 USD) for a non-fatal cardiac event or ischaemic stroke, respectively. The highest costs were related to cardiac complications, followed by non-fatal ischaemic stroke and cardiovascular death. Based on the ABC pathway components, the cost-saving was 719 euros (813 USD) per patient-year for patients in group A vs non-A, 703 euros (794 USD) for B vs non-B, 480 euros (542 USD) for C vs non-C and 2776 euros (3,137 USD) for ABC vs non-ABC.</p><p>The cost per cardiovascular event increased with the number of uncontrolled ABC components: 0-1: 507 euros (573 USD), raising to 965 euros (1,091 USD) for 2 components and to 3,431 euros (3,877 USD) for patients not having any of the three components of the ABC.</p><h3>CONCLUSIONS</h3><p>Management of atrial fibrillation patients according to the ABC pathway was associated with significantly lower health-related costs. Application of the ABC pathway as a management strategy may help reduce healthcare costs related to cardiovascular events in this high-risk patient population.</p>","author":[{"dropping-particle":"","family":"Pastori","given":"Daniele","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Farcomeni","given":"Alessio","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pignatelli","given":"Pasquale","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Violi","given":"Francesco","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory YH","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The American Journal of Medicine","id":"ITEM-1","issue":"0","issued":{"date-parts":[["2019","1"]]},"publisher":"Elsevier","title":"ABC (Atrial fibrillation Better Care) pathway and healthcare costs in atrial fibrillation. The ATHERO-AF study","type":"article-journal","volume":"0"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶²","plainTextFormattedCitation":"62"},"properties":{"noteIndex":0},"schema":""}62. As recently highlighted by some guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.chest.2018.07.040","ISSN":"1931-3543","PMID":"30144419","abstract":"BACKGROUND The risk of stroke is heterogeneous across different groups of patients with atrial fibrillation (AF), being dependent on the presence of various stroke risk factors. We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^17,19","plainTextFormattedCitation":"17,19","previouslyFormattedCitation":"^17,19"},"properties":{"noteIndex":0},"schema":""}17,19, the ABC pathway has been proposed to streamline an integrated and holistic management approach for patients with AF [Figure 3]ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1038/nrcardio.2017.153","ISSN":"1759-5002","PMID":"28960189","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y. H.","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Nature Reviews Cardiology","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2017","9","29"]]},"page":"627-628","title":"The ABC pathway: an integrated approach to improve AF management","type":"article-journal","volume":"14"},"uris":[""]}],"mendeley":{"formattedCitation":"²⁸","plainTextFormattedCitation":"28","previouslyFormattedCitation":"²⁸"},"properties":{"noteIndex":0},"schema":""}28. Significant differences are evicent between the various guidelines examined for some key issues. For example, the CCS guidelines in not indicating the use of OAC in patients <65 years with isolated CADADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF Guidelines recommendations, from 2010 to the present 2016 Focused Update.","author":[{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna L","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issued":{"date-parts":[["2016","9"]]},"language":"ENG","title":"2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-2","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^13,18","plainTextFormattedCitation":"13,18","previouslyFormattedCitation":"^13,18"},"properties":{"noteIndex":0},"schema":""}13,18 represent one example. This notable exception have been firstly reported in the CCS guidelines in the 2012 updateADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2012.01.021","ISSN":"1916-7075","PMID":"22433576","abstract":"The Canadian Cardiovascular Society (CCS) published the complete set of 2010 Atrial Fibrillation (AF) Guidelines in the January, 2011 issue of the Canadian Journal of Cardiology. During its deliberations, the CCS Guidelines Committee engaged to a timely review of future evidence, with periodic composition of focused updates to address clinically important advances. In 2011, results were published from 3 pivotal AF trials: the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF), the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study, and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS), comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden. Each of these large randomized trials provided clear results with major implications for AF management. Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk, stroke risk in paroxysmal-AF patients, risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease, and risk/benefit considerations in the use of antiplatelet agents, alone and in combination with each other or with oral anticoagulants, in AF patients. The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control. This report presents the details of the new recommendations, along with the background and rationale.","author":[{"dropping-particle":"","family":"Skanes","given":"Allan C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gillis","given":"Anne M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2012","1"]]},"page":"125-36","title":"Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control.","type":"article-journal","volume":"28"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶³","plainTextFormattedCitation":"63","previouslyFormattedCitation":"⁶²"},"properties":{"noteIndex":0},"schema":""}63 and it stands on the assumption that CAD implies a low risk of stroke in AF patients (<1.5% per year)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2012.01.021","ISSN":"1916-7075","PMID":"22433576","abstract":"The Canadian Cardiovascular Society (CCS) published the complete set of 2010 Atrial Fibrillation (AF) Guidelines in the January, 2011 issue of the Canadian Journal of Cardiology. During its deliberations, the CCS Guidelines Committee engaged to a timely review of future evidence, with periodic composition of focused updates to address clinically important advances. In 2011, results were published from 3 pivotal AF trials: the Rivaroxaban Once Daily Oral Direct Factor Xa Inhibition Compared with Vitamin K Antagonist for Prevention of Stroke and Embolism Trial in Atrial Fibrillation (ROCKET-AF), the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) study, and the Permanent Atrial Fibrillation Outcome Study Using Dronedarone on Top of Standard Therapy (PALLAS), comparing dronedarone with placebo in patients with permanent AF and additional cardiovascular disease risk-factor burden. Each of these large randomized trials provided clear results with major implications for AF management. Other important evidence that has emerged since the 2010 Guidelines includes findings about prediction instruments for AF-associated stroke and bleeding risk, stroke risk in paroxysmal-AF patients, risk-benefit considerations related to oral anticoagulation in patients with chronic kidney disease, and risk/benefit considerations in the use of antiplatelet agents, alone and in combination with each other or with oral anticoagulants, in AF patients. The Guidelines Committee judged that this extensive and important new evidence required focused updating of the 2010 Guidelines with respect to stroke prevention and rate/rhythm control. This report presents the details of the new recommendations, along with the background and rationale.","author":[{"dropping-particle":"","family":"Skanes","given":"Allan C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gillis","given":"Anne M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issue":"2","issued":{"date-parts":[["2012","1"]]},"page":"125-36","title":"Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control.","type":"article-journal","volume":"28"},"uris":[""]}],"mendeley":{"formattedCitation":"⁶³","plainTextFormattedCitation":"63","previouslyFormattedCitation":"⁶²"},"properties":{"noteIndex":0},"schema":""}63. Several data exist show that in AF patients, the presence of vascular disease and CAD are associated to a significant independent increase in stroke riskADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1111/jth.12177","ISSN":"1538-7836","PMID":"23441593","abstract":"BACKGROUND: Atrial fibrillation (AF) is commonly associated with vascular disease. Although atherosclerotic vascular disease (for example, defined as a myocardial infarction (MI), complex aortic plaque and peripheral arterial disease) has been proposed as a risk factor for a stroke, the co-existence of the two diseases increases the risk of future cardiovascular events. The objective of this study was to conduct a systematic review to assess the impact of atherosclerotic vascular disease on the primary end-point of a stroke, thromboembolism or mortality, in patients with AF.\n\nMETHODS: Literature searches were performed electronically, to identify studies published between January 1990and July 2012 examining stroke and thromboembolism in relation to AF and atherosclerotic vascular disease. Nineteen articles satisfied the pre-inclusion criteria. The bibliographies were subsequently screened to retrieve further relevant studies for this review.\n\nRESULTS: Peripheral arterial disease significantly increased the stroke risk in all 10 observational studies, within a reported risk range of 1.3- to 2.5-fold. Complex aortic plaque on the descending aorta, as identified by trans-oesophageal echocardiography, was also a significant risk factor. Although a prior myocardial infarction (MI) was validated as a significant predictor of the primary end-point amongst five of the six studies, there was a degree of heterogeneity, owing to the marked difference in population sizes and the use of antithrombotic regimens between studies.\n\nCONCLUSION: Atherosclerotic vascular disease (e.g. peripheral arterial disease, complex aortic plaque and prior MI) are significant predictors of a stroke, thromboembolism and mortality in subjects with AF.","author":[{"dropping-particle":"","family":"Anandasundaram","given":"B","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"D A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Apostolakis","given":"S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"G Y H","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of thrombosis and haemostasis : JTH","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2013","5"]]},"page":"975-87","title":"The impact of atherosclerotic vascular disease in predicting a stroke, thromboembolism and mortality in atrial fibrillation patients: a systematic review.","type":"article-journal","volume":"11"},"uris":[""]},{"id":"ITEM-2","itemData":{"DOI":"10.1016/j.jacc.2018.08.1046","ISSN":"1558-3597","PMID":"30157457","author":[{"dropping-particle":"","family":"Steensig","given":"Kamilla","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Olesen","given":"Kevin K W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thim","given":"Troels","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nielsen","given":"Jens C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jensen","given":"Svend E","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jensen","given":"Lisette O","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kristensen","given":"Steen D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"B?tker","given":"Hans Erik","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maeng","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of the American College of Cardiology","id":"ITEM-2","issued":{"date-parts":[["2018","8"]]},"title":"Coronary artery disease is independent risk factor for stroke among patients with atrial fibrillation.","type":"article-journal"},"uris":["",""]},{"id":"ITEM-3","itemData":{"DOI":"10.1055/s-0038-1675401","ISSN":"2567-689X","PMID":"30419601","abstract":"BACKGROUND ?Patients with atrial fibrillation (AF) have an increased risk of ischaemic stroke. The risk can be predicted by the CHA2DS2-VASc score, in which the vascular component refers to previous myocardial infarction, peripheral artery disease and aortic plaque, whereas coronary artery disease (CAD) is not included. OBJECTIVES ?This article explores whether CAD per se or extent provides independent prognostic information of future stroke among patients with AF. MATERIALS AND METHODS ?Consecutive patients with AF and coronary angiography performed between 2004 and 2012 were included. The endpoint was a composite of ischaemic stroke, transient ischaemic attack and systemic embolism. The risk of ischaemic events was estimated according to the presence and extent of CAD. Incidence rate ratios (IRR) were calculated in reference to patients without CAD and adjusted for parameters included in the CHA2DS2-VASc score and treatment with anti-platelet agents and/or oral anticoagulants. RESULTS ?Of 96,430 patients undergoing coronary angiography, 12,690 had AF. Among patients with AF, 7,533 (59.4%) had CAD. Mean follow-up was 3 years. While presence of CAD was an independent risk factor for the composite endpoint (adjusted IRR, 1.25; 1.06-1.47), extent of CAD defined as 1-, 2-, 3- or diffuse vessel disease did not add additional independent risk information. CONCLUSION ?Presence, but not extent, of CAD was an independent risk factor of the composite thromboembolic endpoint beyond the components already included in the CHA2DS2-VASc score. Consequently, we suggest that significant angiographically proven CAD should be included in the vascular disease criterion in the CHA2DS2-VASc score.","author":[{"dropping-particle":"","family":"Steensig","given":"Kamilla","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Olesen","given":"Kevin K W","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Thim","given":"Troels","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nielsen","given":"Jens C","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jensen","given":"Svend E","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Jensen","given":"Lisette O","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kristensen","given":"Steen D","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"B?tker","given":"Hans Erik","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Maeng","given":"Michael","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Thrombosis and haemostasis","id":"ITEM-3","issue":"12","issued":{"date-parts":[["2018","12","12"]]},"page":"2162-2170","title":"Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry.","type":"article-journal","volume":"118"},"uris":[""]}],"mendeley":{"formattedCitation":"^64–66","plainTextFormattedCitation":"64–66","previouslyFormattedCitation":"^63–65"},"properties":{"noteIndex":0},"schema":""}64–66. Even more differences are related to those issues for which a lower quality of evidence and strength of recommendations is available. These reflect the lack of high-quality data obtained from randomized controlled trials and underline the need for future well-designed and adequately powered studies.The use of an approach based on expert consensus review of the published evidence for the APHRS and KHRS guidelinesADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]},{"id":"ITEM-2","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-2","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["","",""]}],"mendeley":{"formattedCitation":"^15,19","plainTextFormattedCitation":"15,19","previouslyFormattedCitation":"^15,19"},"properties":{"noteIndex":0},"schema":""}15,19 could impact on the daily clinical decision-making process, but when a high quality of evidence is available these guidelines are still able to provide solid recommendations. For all the other aspects for which there is a significant degree of uncertainty, there may be a less objective evaluation of the limited scientific evidence available. In any case, many guidelines that use systematic reviews still include many recommendations with Level of Evidence C, which represents expert consensus anyway. CONCLUSIONIn this narrative review of contemporary guidelines, there is general agreement on the baseline evaluation of thromboembolic and bleeding risk, as well as a preference for the use of NOACs. More data are still needed to better substantiate recommendations for specific AF subpopulations. The need for an integrated approach and holistic management is highlighted in the more recently published guidelines.FUNDINGNo funding was used to prepare this paper.DISCLOSURE OF INTERESTSMP reports consulting activity for Boehringer Ingelheim; DAL reports investigator-initiated educational grants from Bristol-Myers Squibb and Boehringer Ingelheim; speaker activity for Boehringer Ingelheim, Bayer and Bristol-Myers Squibb /Pfizer; consultant activity for Bristol-Myers Squibb, Bayer, Boehringer Ingelheim and Daiichi-Sankyo; She is a member of the ACCP 2018 writing committee; GB has received small speaker’s fee from Medtronic, Boston, Boehringer and Bayer, outside the submitted work; He is a member of the ACCP 2018 writing committee; GYHL has served as consultant for Bayer/Janssen, BMS/Pfizer, Medtronic, Boehringer Ingelheim, Novartis, Verseon and Daiichi-Sankyo; and speaker for Bayer, BMS/Pfizer, Medtronic, Boehringer Ingelheim, and Daiichi-Sankyo. He is member and chair of the ACCP 2018 writing committee. No fees are received personally. REFERENCESADDIN Mendeley Bibliography CSL_BIBLIOGRAPHY 1. Lip G, Freedman B, De Caterina R, Potpara TS. Stroke prevention in atrial fibrillation: Past, present and future. Comparing the guidelines and practical decision-making. Thromb. Haemost. 2017;117(7):1230-1239. doi:10.1160/TH16-11-0876.2. Ruff CT, Giugliano RP, Braunwald E, 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 2013. doi:10.1016/S0140-6736(13)62343-0.3. Gadsb?ll K, Staerk L, Loldrup Fosb?l E, et al. Increased use of oral anticoagulants in patients with atrial fibrillation: temporal trends from 2005 to 2015 in Denmark. Eur. Heart J. 2017;38(12):899-906. doi:10.1093/eurheartj/ehw658.4. Marzec LN, Wang J, Shah ND, et al. Influence of Direct Oral Anticoagulants on Rates of Oral Anticoagulation for Atrial Fibrillation. J. Am. Coll. Cardiol. 2017;69(20):2475-2484. doi:10.1016/j.jacc.2017.03.540.5. Camm AJ, Accetta G, Ambrosio G, et al. Evolving antithrombotic treatment patterns for patients with newly diagnosed atrial fibrillation. Heart 2017;103(4):307-314. doi:10.1136/heartjnl-2016-309832.6. Boriani G, Proietti M, Laroche C, et al. Contemporary stroke prevention strategies in 11 096 European patients with atrial fibrillation: a report from the EURObservational Research Programme on Atrial Fibrillation (EORP-AF) Long-Term General Registry. Europace 2017;(November):1-11. doi:10.1093/europace/eux301.7. Marijon E, Le Heuzey J-Y, Connolly S, et al. Causes of death and influencing factors in patients with atrial fibrillation: a competing-risk analysis from the randomized evaluation of long-term anticoagulant therapy study. Circulation 2013;128(20):2192-2201. doi:10.1161/CIRCULATIONAHA.112.000491.8. Fauchier L, Villejoubert O, Clementy N, et al. Causes of Death and Influencing Factors in Patients with Atrial Fibrillation. Am. J. Med. 2016. doi:10.1016/j.amjmed.2016.06.045.9. Proietti M, Laroche C, Opolski G, et al. “Real-world” atrial fibrillation management in Europe: observations from the 2-year follow-up of the EURObservational Research Programme-Atrial Fibrillation General Registry Pilot Phase. Europace 2017;19(5):722-733. doi:10.1093/europace/euw112.10. Proietti M, Laroche C, Nieuwlaat R, et al. Increased burden of comorbidities and risk of cardiovascular death in atrial fibrillation patients in Europe over ten years: A comparison between EORP-AF pilot and EHS-AF registries. Eur. J. Intern. Med. 2018. doi:10.1016/j.ejim.2018.05.016.11. Kotecha D, Breithardt G, Camm AJ, et al. Integrating new approaches to atrial fibrillation management: The 6th AFNET/EHRA Consensus Conference. Europace 2018;20(3):395-407. doi:10.1093/europace/eux318.12. Kirchhof P. The future of atrial fibrillation management: integrated care and stratified therapy. Lancet (London, England) 2017;390(10105):1873-1887. doi:10.1016/S0140-6736(17)31072-3.13. Macle L, Cairns J, Leblanc K, et al. 2016 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. Can. J. Cardiol. 2016. doi:10.1016/j.cjca.2016.07.591.14. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur. Heart J. 2016;37(38):2893-2962. doi:10.1093/eurheartj/ehw210.15. Chiang C-E, Okumura K, Zhang S, et al. 2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation. J. Arrhythmia 2017;33(4):345-367. doi:10.1016/j.joa.2017.05.004.16. NHFA CSANZ Atrial Fibrillation Guideline Working Group D, Brieger D, Amerena J, et al. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart. Lung Circ. 2018;27(10):1209-1266. doi:10.1016/j.hlc.2018.06.1043.17. Lip GYH, Banerjee A, Boriani G, et al. Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report. Chest 2018;154(5):1121-1201. doi:10.1016/j.chest.2018.07.040.18. Andrade JG, Verma A, Mitchell LB, et al. 2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation. Can. J. Cardiol. 2018;34(11):1371-1392. doi:10.1016/j.cjca.2018.08.026.19. Joung B, Lee JM, Lee KH, et al. 2018 Korean Guideline of Atrial Fibrillation Management. Korean Circ. J. 2018;48(12):1033. doi:10.4070/kcj.2018.0339.20. Gillis AM, Skanes AC, Committee CCSAFG. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: implementing GRADE and achieving consensus. Can J Cardiol 2011;27(1):27-30. doi:10.1016/j.cjca.2010.11.003.21. Camm AJ, Kirchhof P, Lip GYH, et al. Guidelines for the management of atrial fibrillation. Eur. Heart J. 2010;31(19):2369-2429. doi:10.1093/eurheartj/ehq278.22. Camm A, Lip G, De Caterina R, et al. 2012 focused update of the ESC Guidelines for the management of atrial fibrillation: an update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Hear. J 2012;33:2719-2747.23. 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):2864-70. Available at: . Accessed November 3, 2014.24. Soliman EZ, Safford MM, Muntner P, et al. Atrial fibrillation and the risk of myocardial infarction. JAMA Intern. Med. 2014;174(1):107-14. doi:10.1001/jamainternmed.2013.11912.25. Soliman EZ, Lopez F, O’Neal WT, et al. Atrial Fibrillation and Risk of ST-Segment-Elevation Versus Non-ST-Segment-Elevation Myocardial Infarction: The Atherosclerosis Risk in Communities (ARIC) Study. Circulation 2015;131(21):1843-50. doi:10.1161/CIRCULATIONAHA.114.014145.26. Violi F, Davì G, Proietti M, et al. Ankle-Brachial Index and cardiovascular events in atrial fibrillation: The ARAPACIS study. Thromb. Haemost. 2016;115(4). doi:10.1160/TH15-07-0612.27. Lau YC, Proietti M, Guiducci E, Blann AD, Lip GYH. Atrial Fibrillation and Thromboembolism in?Patients With Chronic Kidney Disease. J. Am. Coll. Cardiol. 2016;68(13). doi:10.1016/j.jacc.2016.06.057.28. Lip GYH. The ABC pathway: an integrated approach to improve AF management. Nat. Rev. Cardiol. 2017;14(11):627-628. doi:10.1038/nrcardio.2017.153.29. Ganesan AN, Chew DP, Hartshorne T, et al. The impact of atrial fibrillation type on the risk of thromboembolism, mortality, and bleeding: a systematic review and meta-analysis. Eur. Heart J. 2016;37(20):1591-1602. doi:10.1093/eurheartj/ehw007.30. Proietti M, Mujovic N, Potpara TS. Optimizing Stroke and Bleeding Risk Assessment in Patients with Atrial Fibrillation: A Balance of Evidence, Practicality and Precision. Thromb. Haemost. 2018;118(12):2014-2017. doi:10.1055/s-0038-1676074.31. Oldgren J, Hijazi Z, Lindb?ck J, et al. Performance and Validation of a Novel Biomarker-Based Stroke Risk Score for Atrial FibrillationClinical Perspective. Circulation 2016;134(22):1697-1707. doi:10.1161/CIRCULATIONAHA.116.022802.32. Borre ED, Goode A, Raitz G, et al. Predicting Thromboembolic and Bleeding Event Risk in Patients with Non-Valvular Atrial Fibrillation: A Systematic Review. Thromb. Haemost. 2018;118(12):2171-2187. doi:10.1055/s-0038-1675400.33. Proietti M, Farcomeni A, Romiti GF, 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. 2018:204748731881766. doi:10.1177/2047487318817662.34. Lane DA, Lip GYH. Female gender is a risk factor for stroke and thromboembolism in atrial fibrillation patients. Thromb. Haemost. 2009;101(5):802-5.35. Poli D, Antonucci E. Epidemiology, diagnosis, and management of atrial fibrillation in women. Int. J. Womens. Health 2015;7:605-14. doi:10.2147/IJWH.S45925.36. Marzona I, Proietti M, Farcomeni A, 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. doi:10.1016/j.ijcard.2018.07.044.37. Nielsen PB, Skj?th F, Overvad TF, Larsen TB, Lip GYH. 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(8):832-840. doi:10.1161/CIRCULATIONAHA.117.029081.38. Senoo K, Proietti M, Lane DA, Lip GYH. Evaluation of the HAS-BLED, ATRIA and ORBIT bleeding risk scores in atrial fibrillation patients on warfarin. Am. J. Med. 2015. doi:10.1016/j.amjmed.2015.10.001.39. Proietti M, Senoo K, Lane DA, Lip GYH. Major Bleeding in Patients with Non-Valvular Atrial Fibrillation: Impact of Time in Therapeutic Range on Contemporary Bleeding Risk Scores. Sci. Rep. 2016;6:24376. doi:10.1038/srep24376.40. Esteve-Pastor MA, Rivera-Caravaca JM, Roldan V, et al. Long-term bleeding risk prediction in “real world” patients with atrial fibrillation: Comparison of the HAS-BLED and ABC-Bleeding risk scores. The Murcia Atrial Fibrillation Project. Thromb Haemost 2017;117(10):1848-1858. doi:10.1160/th17-07-0478.41. Proietti M, Rivera‐Caravaca JM, Esteve‐Pastor MA, Romiti GF, Marin F, Lip GYH. Predicting Bleeding Events in Anticoagulated Patients With Atrial Fibrillation: A Comparison Between the HAS‐BLED and GARFIELD‐AF Bleeding Scores. J. Am. Heart Assoc. 2018;7(18). doi:10.1161/JAHA.118.009766.42. Chao T-F, Lip GYH, Lin Y-J, 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(4):768-777. doi:10.1055/s-0038-1636534.43. Esteve-Pastor MA, Rivera-Caravaca JM, Shantsila A, Roldán V, Lip GYH, 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(12):2261-2266. doi:10.1160/TH17-10-0710.44. Carmo J, Moscoso Costa F, Ferreira J, Mendes M. Dabigatran in real-world atrial fibrillation. Meta-analysis of observational comparison studies with vitamin K antagonists. Thromb. Haemost. 2016;116(4):754-763. doi:10.1160/TH16-03-0203.45. Bai Y, Deng H, Shantsila A, Lip GYH. Rivaroxaban Versus Dabigatran or Warfarin in Real-World Studies of Stroke Prevention in Atrial Fibrillation. Stroke 2017;48(4):970-976. doi:10.1161/STROKEAHA.116.016275.46. Proietti M, Romanazzi I, Romiti GF, Farcomeni A, Lip GYH. Real-world use of apixaban for stroke prevention in atrial fibrillation: A systematic review and meta-analysis. Stroke 2018;49(1):98-106. doi:10.1161/STROKEAHA.117.018395.47. Zulkifly H, Lip GYH, Lane DA. Use of the SAMe-TT 2 R 2 score to predict anticoagulation control in atrial fibrillation and venous thromboembolism patients receiving vitamin K antagonists: A review. Hear. Rhythm 2018;15(4):615-623. doi:10.1016/j.hrthm.2017.11.026.48. Dewilde WJM, Oirbans T, Verheugt FWA, et al. Use of clopidogrel with or without aspirin in patients taking oral anticoagulant therapy and undergoing percutaneous coronary intervention: an open-label, randomised, controlled trial. Lancet 2013;381(9872):1107-1115. doi:10.1016/S0140-6736(12)62177-1.49. Proietti M, Airaksinen KEJJ, Rubboli A, et al. Time in therapeutic range and major adverse outcomes in atrial fibrillation patients undergoing percutaneous coronary intervention: The Atrial Fibrillation Undergoing Coronary Artery Stenting (AFCAS) registry. Am. Heart J. 2017;190:86-93. doi:10.1016/j.ahj.2017.05.016.50. Lip GYH, Collet J-P, Haude M, et al. 2018 Joint European consensus document on the management of antithrombotic therapy in atrial fibrillation patients presenting with acute coronary syndrome and/or undergoing percutaneous cardiovascular interventions: a joint consensus document of the Europ. Europace 2018. doi:10.1093/europace/euy174.51. Gibson CM, Mehran R, Bode C, et al. Prevention of Bleeding in Patients with Atrial Fibrillation Undergoing PCI. N. Engl. J. Med. 2016;375(25):2423-2434. doi:10.1056/NEJMoa1611594.52. Cannon CP, Bhatt DL, Oldgren J, et al. Dual Antithrombotic Therapy with Dabigatran after PCI in Atrial Fibrillation. N. Engl. J. Med. 2017:NEJMoa1708454. doi:10.1056/NEJMoa1708454.53. Gong X, Tang S, Li J, Zhang X, Tian X, Ma S. Antithrombotic therapy strategies for atrial fibrillation patients undergoing percutaneous coronary intervention: A systematic review and network meta-analysis. Pizzi C, ed. PLoS One 2017;12(10):e0186449. doi:10.1371/journal.pone.0186449.54. Ge Z, Faggioni M, Baber U, et al. Safety and efficacy of nonvitamin K antagonist oral anticoagulants during catheter ablation of atrial fibrillation: A systematic review and meta-analysis. Cardiovasc. Ther. 2018;36(5):e12457. doi:10.1111/1755-5922.12457.55. Zhao Y, Lu Y, Qin Y. A meta-analysis of randomized controlled trials of uninterrupted periprocedural anticoagulation strategy in patients undergoing atrial fibrillation catheter ablation. Int. J. Cardiol. 2018;270:167-171. doi:10.1016/j.ijcard.2018.06.024.56. Brunetti ND, Tarantino N, De Gennaro L, Correale M, Santoro F, Di Biase M. Direct oral anti-coagulants compared to vitamin-K antagonists in cardioversion of atrial fibrillation: an updated meta-analysis. J. Thromb. Thrombolysis 2018;45(4):550-556. doi:10.1007/s11239-018-1622-5.57. Lopes RD, Alings M, Connolly SJ, et al. Rationale and design of the Apixaban for the Reduction of Thrombo-Embolism in Patients With Device-Detected Sub-Clinical Atrial Fibrillation (ARTESiA) trial. Am. Heart J. 2017;189:137-145. doi:10.1016/j.ahj.2017.04.008.58. Kirchhof P, Blank BF, Calvert M, et al. Probing oral anticoagulation in patients with atrial high rate episodes: Rationale and design of the Non-vitamin K antagonist Oral anticoagulants in patients with Atrial High rate episodes (NOAH-AFNET 6) trial. Am. Heart J. 2017;190:12-18. doi:10.1016/j.ahj.2017.04.015.59. Gallagher C, Elliott AD, Wong CX, et al. Integrated care in atrial fibrillation: A systematic review and meta-analysis. Heart 2017;103(24):1947-1953. doi:10.1136/heartjnl-2016-310952.60. Proietti M, Romiti GF, Olshansky B, Lane DA, Lip GYH. Improved Outcomes by Integrated Care of Anticoagulated Patients with Atrial Fibrillation Using the Simple ABC (Atrial Fibrillation Better Care) Pathway. Am. J. Med. 2018. doi:10.1016/j.amjmed.2018.06.012.61. Pastori D, Pignatelli P, Menichelli D, Violi F, Lip GYH. Integrated Care Management of Patients With Atrial Fibrillation and Risk of Cardiovascular Events. Mayo Clin. Proc. 2018. doi:10.1016/j.mayocp.2018.10.022.62. Pastori D, Farcomeni A, Pignatelli P, Violi F, Lip GY. ABC (Atrial fibrillation Better Care) pathway and healthcare costs in atrial fibrillation. The ATHERO-AF study. Am. J. Med. 2019;0(0). doi:10.1016/j.amjmed.2019.01.003.63. Skanes AC, Healey JS, Cairns JA, et al. Focused 2012 update of the Canadian Cardiovascular Society atrial fibrillation guidelines: recommendations for stroke prevention and rate/rhythm control. Can. J. Cardiol. 2012;28(2):125-36. doi:10.1016/j.cjca.2012.01.021.64. Anandasundaram B, Lane DA, Apostolakis S, Lip GYH. The impact of atherosclerotic vascular disease in predicting a stroke, thromboembolism and mortality in atrial fibrillation patients: a systematic review. J. Thromb. Haemost. 2013;11(5):975-87. doi:10.1111/jth.12177.65. Steensig K, Olesen KKW, Thim T, et al. Coronary artery disease is independent risk factor for stroke among patients with atrial fibrillation. J. Am. Coll. Cardiol. 2018. doi:10.1016/j.jacc.2018.08.1046.66. Steensig K, Olesen KKW, Thim T, et al. Should the Presence or Extent of Coronary Artery Disease be Quantified in the CHA2DS2-VASc Score in Atrial Fibrillation? A Report from the Western Denmark Heart Registry. Thromb. Haemost. 2018;118(12):2162-2170. doi:10.1055/s-0038-1675401.FIGURE LEGENDSFigure 1: Proportion of Papers Related to Atrial Fibrillation in PubMed from Inception to 2017Legend: AF= Atrial FibrillationFigure 2: The ‘Birmingham 3-Step’ Management Strategy for Anticoagulation in Patients with Atrial FibrillationLegend: NOAC= Non-vitamin K Antagonist Oral Anticoagulant; OAC= Oral Anticoagulant; TTR= Time in Therapeutic Range; VKA= Vitamin K Antagonist.Figure 3: Atrial Fibrillation Better Care (ABC) Pathway for Integrated Care in Atrial Fibrillation PatientsTable 1: Summary of General Characteristics and Definitions of Contemporary Atrial Fibrillation Guidelines CCSESCAPHRSYear201620162017Primary SourceCJC 2016; 32 (10)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2016.07.591","ISSN":"1916-7075 (Electronic)","PMID":"27609430","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation (AF) Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in AF management. This 2016 Focused Update deals with: (1) the management of antithrombotic therapy for AF patients in the context of the various clinical presentations of coronary artery disease; (2) real-life data with non-vitamin K antagonist oral anticoagulants; (3) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (4) digoxin as a rate control agent; (5) perioperative anticoagulation management; and (6) AF surgical therapy including the prevention and treatment of AF after cardiac surgery. The recommendations were developed with the same methodology used for the initial 2010 guidelines and the 2012 and 2014 Focused Updates. Using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards, individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included in the Supplementary Material, and on the CCS Web site. The section on concomitant AF and coronary artery disease was developed in collaboration with the CCS Antiplatelet Guidelines Committee. Details of the updated recommendations are presented, along with their background and rationale. 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and healthcare burden of atrial fibrillation 12 3.3 Impact of evidence-based management on outcomes in atrial fibrillation patients 12 3.4 Gender 134 Pathophysiological and genetic aspects that guide management 14 4.1 Genetic predisposition 14 4.2 Mechanisms leading to atrial fibrillation 14 4.2.1 Remodelling of atrial structure and ion channel function 14 4.2.2 Electrophysiological mechanisms of atrial fibrillation 165 Diagnosis and timely detection of atrial fibrillation 17 5.1 Overt and silent atrial fibrillation 17 5.2 Screening for silent atrial fibrillation 17 5.2.1 Screening for atrial fibrillation by electrocardiogram in the community 17 5.2.2 Prolonged monitoring for paroxysmal atrial fibrillation 17 5.2.3 Patients with pacemakers and implanted devices 17 5.2.4 Detection of atrial fibrillation in stroke survivors 18 5.3 Electrocardiogram detection of atrial flutter 196 Classification of atrial fibrillation 19 6.1 Atrial fibrillation pattern 19 6.2 Atrial fibrillation types reflecting different causes of the arrhythmia 20 6.3 Symptom burden in atrial fibrillation 207 Detection and management of risk factors and concomitant cardiovascular diseases 21 7.1 Heart failure 22 7.1.1 Patients with atrial fibrillation and heart failure with reduced ejection fraction 23 7.1.2 Atrial fibrillation patients with heart failure with preserved ejection fraction 24 7.1.3 Atrial fibrillation patients with heart failure with mid-range ejection fraction 24 7.1.4 Prevention of atrial fibrillation in heart failure 25 7.2 Hypertension 25 7.2.1 Treatment of hypertension to prevent incident atrial fibrillation 25 7.2.2 Blood pressure control in patients 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Guidelines for the management of atrial fibrillation developed in collaboration with EACTS","type":"article","volume":"37"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁴","plainTextFormattedCitation":"14","previouslyFormattedCitation":"¹⁴"},"properties":{"noteIndex":0},"schema":""}14J Arrhythmia 2017; 33 (4)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.joa.2017.05.004","ISSN":"1880-4276","PMID":"28765771","abstract":"Atrial fibrillation (AF) is the most common sustained arrhythmia, causing a 2-fold increase in mortality and a 5-fold increase in stroke. The Asian population is rapidly aging, and in 2050, the estimated population with AF will reach 72 million, of whom 2.9 million may suffer from AF-associated stroke. Therefore, stroke prevention in AF is an urgent issue in Asia. Many innovative advances in the management of AF-associated stroke have emerged recently, including new scoring systems for predicting stroke and bleeding risks, the development of non-vitamin K antagonist oral anticoagulants (NOACs), knowledge of their special benefits in Asians, and new techniques. The Asia Pacific Heart Rhythm Society (APHRS) aimed to update the available information, and appointed the Practice Guideline sub-committee to write a consensus statement regarding stroke prevention in AF. The Practice Guidelines sub-committee members comprehensively reviewed updated information on stroke prevention in AF, emphasizing data on NOACs from the Asia Pacific region, and summarized them in this 2017 Consensus of the Asia Pacific Heart Rhythm Society on Stroke Prevention in AF. This consensus includes details of the updated recommendations, along with their background and rationale, focusing on data from the Asia Pacific region. We hope this consensus can be a practical tool for cardiologists, neurologists, geriatricians, and general practitioners in this region. We fully realize that there are gaps, unaddressed questions, and many areas of uncertainty and debate in the current knowledge of AF, and the physician?s decision remains the most important factor in the management of AF.","author":[{"dropping-particle":"","family":"Chiang","given":"Chern-En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Okumura","given":"Ken","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Zhang","given":"Shu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chao","given":"Tze-Fan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siu","given":"Chung-Wah","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wei Lim","given":"Toon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Saxena","given":"Anil","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Takahashi","given":"Yoshihide","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Siong Teo","given":"Wee","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Journal of Arrhythmia","id":"ITEM-1","issue":"4","issued":{"date-parts":[["2017","8"]]},"page":"345-367","title":"2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation.","type":"article-journal","volume":"33"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁵","plainTextFormattedCitation":"15","previouslyFormattedCitation":"¹⁵"},"properties":{"noteIndex":0},"schema":""}15Guidelines MethodologySystematic search according to PICO;GRADE rating of evidenceSystematic search according to PICOT;Experts plenary discussionExpert Consensus ReviewStrength of RecommendationsStrong, Conditional, WeakClasses I-IIa-IIb-IIINot explicitly assessedQuality of EvidenceHigh, Moderate, Low, Very LowLevel A-B-CNot explicitly assessedConflict of Interest ProcessNot ReportedDetailed disclosure of all real or potential sources of COI publicly availableReported in acknowledgmentClassification of AFNew onset, paroxysmal, persistent or permanentFirst diagnosed, paroxysmal, persistent, long-standing persistent, permanentNot explicitEvaluation of Valvular Origin Rheumatic mitral stenosis, mitral valve repair, mechanical or bio- prosthetic heart valveRheumatic valvular disease (predominantly mitral stenosis)or mechanical heart valvesNot explicitly assessedTable 1 (continued): Summary of General Characteristics and Definitions of Contemporary Atrial Fibrillation GuidelinesNHFA/CSANZACCPCCSKHRSYear2018201820182018Primary SourceHLC 2018; 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We provide recommendations for antithrombotic treatment based on net clinical benefit for patients with AF at varying levels of stroke risk and in a number of common clinical scenarios. METHODS Systematic literature reviews were conducted to identify relevant articles published from the last formal search perfomed for the Antithrombotic and Thrombolytic Therapy: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (9th Edition). The overall quality of the evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluation) approach. Graded recommendations and ungraded consensus-based statements were drafted, voted on, and revised until consensus was reached. RESULTS For patients with AF without valvular heart disease, including those with paroxysmal AF, who are at low risk of stroke (eg, CHA2DS2-VASc [congestive heart failure, hypertension, age?≥ 75 (doubled), diabetes, stroke (doubled)-vascular disease, age 65-74 and sex category (female)] score of 0 in males or 1 in females), we suggest no antithrombotic therapy. The next step is to consider stroke prevention (ie, oral anticoagulation therapy) for patients with 1 or more non-sex CHA2DS2-VASc stroke risk factors. For patients with a single non-sex CHA2DS2-VASc stroke risk factor, we suggest oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel; and for those at high risk of stroke (eg, CHA2DS2-VASc?≥ 2 in males or?≥ 3 in females), we recommend oral anticoagulation rather than no therapy, aspirin, or combination therapy with aspirin and clopidogrel. Where we recommend or suggest in favor of oral anticoagulation, we suggest using a non-vitamin K antagonist oral anticoagulant drug rather than adjusted-dose vitamin K antagonist therapy. With the latter, it is important to aim for good quality anticoagulation control with a time in therapeutic range > 70%. Attention to modifiable bleeding risk factors (eg, uncontrolled BP, labile international normalized ratios, concomitant use of aspirin or nonsteroidal antiinflammatory drugs in an anticoagulated patient, alcohol excess) should be made at each patient contact, and HAS-BLED (hypertension, abnormal renal/liver function [1 point each], stroke, bleeding history or pred…","author":[{"dropping-particle":"","family":"Lip","given":"Gregory Y H","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Banerjee","given":"Amitava","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Boriani","given":"Giuseppe","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Chiang","given":"Chern En","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Fargo","given":"Ramiz","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Freedman","given":"Ben","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lane","given":"Deirdre A","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Ruff","given":"Christian T","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Turakhia","given":"Mintu","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Werring","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Patel","given":"Sheena","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Moores","given":"Lisa","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Chest","id":"ITEM-1","issue":"5","issued":{"date-parts":[["2018","11"]]},"page":"1121-1201","title":"Antithrombotic Therapy for Atrial Fibrillation: CHEST Guideline and Expert Panel Report.","type":"article-journal","volume":"154"},"uris":[""]}],"mendeley":{"formattedCitation":"¹⁷","plainTextFormattedCitation":"17","previouslyFormattedCitation":"¹⁷"},"properties":{"noteIndex":0},"schema":""}17CJC 2018; 34 (11)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.1016/j.cjca.2018.08.026","ISSN":"1916-7075","PMID":"30404743","abstract":"The Canadian Cardiovascular Society (CCS) Atrial Fibrillation Guidelines Committee provides periodic reviews of new data to produce focused updates that address clinically important advances in atrial fibrillation (AF) management. This 2018 Focused Update addresses: (1) anticoagulation in the context of cardioversion of AF; (2) the management of antithrombotic therapy for patients with AF in the context of coronary artery disease; (3) investigation and management of subclinical AF; (4) the use of antidotes for the reversal of non-vitamin K antagonist oral anticoagulants; (5) acute pharmacological cardioversion of AF; (6) catheter ablation for AF, including patients with concomitant AF and heart failure; and (7) an integrated approach to the patient with AF and modifiable cardiovascular risk factors. The recommendations were developed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) standards. Individual studies and literature were reviewed for quality and bias; the literature review process and evidence tables are included as Supplementary Material and are available on the CCS Web site. Details of the updated recommendations are presented, along with their background and rationale. This document is linked to an updated summary of all CCS AF guidelines recommendations, from 2010 to the present 2018 Focused Update, which is provided in the Supplementary Material.","author":[{"dropping-particle":"","family":"Andrade","given":"Jason G","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Atul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Mitchell","given":"L Brent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Parkash","given":"Ratika","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Leblanc","given":"Kori","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Atzema","given":"Clare","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Healey","given":"Jeff S","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Bell","given":"Alan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cairns","given":"John","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Connolly","given":"Stuart","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Cox","given":"Jafna","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Dorian","given":"Paul","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Gladstone","given":"David","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"McMurtry","given":"M Sean","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nair","given":"Girish M","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Pilote","given":"Louise","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sarrazin","given":"Jean-Francois","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Sharma","given":"Mike","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Skanes","given":"Allan","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Talajic","given":"Mario","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Tsang","given":"Teresa","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Verma","given":"Subodh","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Wyse","given":"D George","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Nattel","given":"Stanley","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Macle","given":"Laurent","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"CCS Atrial Fibrillation Guidelines Committee","given":"","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"The Canadian journal of cardiology","id":"ITEM-1","issue":"11","issued":{"date-parts":[["2018","11"]]},"page":"1371-1392","title":"2018 Focused Update of the Canadian Cardiovascular Society Guidelines for the Management of Atrial Fibrillation.","type":"article-journal","volume":"34"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁸","plainTextFormattedCitation":"18","previouslyFormattedCitation":"¹⁸"},"properties":{"noteIndex":0},"schema":""}18KCJ 2018; 48 (12)ADDIN CSL_CITATION {"citationItems":[{"id":"ITEM-1","itemData":{"DOI":"10.4070/kcj.2018.0339","ISSN":"1738-5520","author":[{"dropping-particle":"","family":"Joung","given":"Boyoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Jung Myung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Ki Hong","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Tae-Hoon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Choi","given":"Eue-Keun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Woo-Hyun","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kang","given":"Ki-Woon","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Shim","given":"Jaemin","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lim","given":"Hong Euy","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Park","given":"Junbeom","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"So-Ryoung","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Lee","given":"Young Soo","non-dropping-particle":"","parse-names":false,"suffix":""},{"dropping-particle":"","family":"Kim","given":"Jin-Bae","non-dropping-particle":"","parse-names":false,"suffix":""}],"container-title":"Korean Circulation Journal","id":"ITEM-1","issue":"12","issued":{"date-parts":[["2018"]]},"page":"1033","title":"2018 Korean Guideline of Atrial Fibrillation Management","type":"article-journal","volume":"48"},"uris":["",""]}],"mendeley":{"formattedCitation":"¹⁹","plainTextFormattedCitation":"19","previouslyFormattedCitation":"¹⁹"},"properties":{"noteIndex":0},"schema":""}19Guidelines MethodologySystematic search according to Clinical Questions;GRADE rating of evidenceSystematic search according to PICO-guided Clinical Questions;GRADE rating of evidenceSystematic search according to PICO;GRADE rating of evidenceExpert Consensus ReviewStrength of RecommendationsStrong, WeakStrong, WeakStrong, Conditional, WeakClasses I-IIa-IIb-IIIQuality of EvidenceHigh, Moderate, LowHigh, Moderate, Low, Very LowHigh, Moderate, Low, Very LowLevel A-B-CConflict of Interest ProcessDirect or indirect relationship to any third party, both financial and non-financialCentral COIs review. If manageable potential COI, voting on relevant issues was prohibitedNot ReportedReported in acknowledgmentClassification of AFParoxysmal, persistent, long-standing persistent, permanentParoxysmal, persistent, long-standing persistent, permanentNew onset, paroxysmal, persistent or permanentNot explicitEvaluation of Valvular Origin Moderate to severemitral stenosis or mechanical heart valveModerate to severemitral stenosis or mechanical heart valveRheumatic mitral stenosis, moderate-severe nonrheumatic mitral stenosis, or a mechanical heart valveNot explicitly assessedLegend: APHRS= Asia Pacific Heart Rhythm Society; CCS= Canadian Cardiovascular Society; CJC= Canadian Journal of Cardiology; COI= Conflict of Interest; CSANZ= Cardiac Society of Australia and New Zealand; EHJ= European Heart Journal; ESC= European Society of Cardiology; GRADE= Grading of Recommendations, Assessment, Development and Evaluation; HLC= Heart, Lung and Circulation; KCJ= Korean Circulation Journal; NHFA= National Heart Foundation of Australia; PICO(T)= Population, Intervention, Comparison, Outcome, (Time).Table 2: Baseline Thromboembolic Risk Evaluation and Oral Anticoagulation Prescription AlgorithmCCSESCAPHRSYear201620162017Thromboembolic Risk AssessmentCHADS-65(‘CCS Algorithm’)CHA2DS2-VAScCHA2DS2-VAScRating of EvidenceStrong Recommendation, High-Quality EvidenceClass I, Level ANot ratedOAC Prescription AlgorithmOAC should be considered for all patients ≥65 years old or with ≥1 CHADS2 risk factors.<65 years old and with arterial disease ASA should be consideredOAC is indicated in all patients with a CHA2DS2-VASc ≥2, excluding sex categoryOAC should be considered in all patients with just 1 CHA2DS2-VASc risk factors, excluding sex categoryOAC is indicated in all patients with a CHA2DS2-VASc ≥1, excluding sex categoryRating of EvidenceStrong Recommendation, Moderate-Quality EvidenceConditional Recommendation, Moderate-Quality EvidenceClass I, Level AClass IIa, Level BNot ratedUse of NOACsA NOAC is preferred over VKAA NOAC is preferred over VKAA NOAC is preferred over VKARating of EvidenceStrong Recommendation, High-Quality EvidenceClass I, Level ANot ratedTable 2 (continued): Baseline Thromboembolic Risk Evaluation and Oral Anticoagulation Prescription AlgorithmNHFA/CSANZACCPCCSKHRSYear2018201820182018Thromboembolic Risk AssessmentCHA2DS2-VACHA2DS2-VAScCHADS-65(‘CCS Algorithm’)CHA2DS2-VAScRating of EvidenceStrong Recommendation,Moderate-Quality EvidenceStrong Recommendation,Moderate-Quality EvidenceStrong Recommendation, High-Quality Evidence (2014)Class I, Level AOAC Prescription Algorithmi) OAC is indicated in all patients with CHA2DS2-VA ≥2ii) OAC should be considered in all patients with CHA2DS2-VA 1OAC is indicated in all patients with a CHA2DS2-VASc ≥1, excluding sex categoryOAC should be considered for all patients ≥65 years old or with ≥1 CHADS2 risk factors. <65 years old and with arterial disease ASA should be consideredOAC is indicated in all patients with a CHA2DS2-VASc ≥2, excluding sex category OAC should be considered in all patients with just 1 CHA2DS2-VASc risk factors, excluding sex categoryRating of Evidencei) Strong Recommendation,High-Quality Evidenceii) Strong Recommendation,Moderate-Quality EvidenceStrong Recommendation,Moderate-Quality Evidencei) Strong Recommendation, Moderate-Quality Evidenceii) Conditional Recommendation, Moderate-Quality Evidence (2014)i) Class I, Level Aii) Class IIa, Level BUse of NOACsA NOAC is preferred over VKAA NOAC is preferred over VKAA NOAC is preferred over VKAA NOAC is preferred over VKARating of EvidenceStrong Recommendation,Moderate-Quality EvidenceStrong Recommendation,Moderate-Quality EvidenceStrong Recommendation,High-Quality Evidence (2014)Class I, Level ALegend: ASA= Acetylsalicylic acid; CHADS= Congestive Heart Failure, Hypertension, Age, Diabetes Mellitus, Stroke/Transient Ischemic Attack; CHA2DS2-VASc= Congestive Heart Failure, Hypertension, Age≥75 years, Diabetes Mellitus, Stroke/Transient Ischemic Attack, Vascular Disease, Age 65-74 years, Sex category; NOAC= Non-vitamin K antagonist oral anticoagulant; OAC= Oral anticoagulant; VKA= Vitamin K Antagonist; for other acronyms please see Table 1 legend.Table 3: Baseline Bleeding Risk Evaluation and Associated RecommendationsCCSESCAPHRSYear201620162017Bleeding Risk AssessmentHAS-BLEDUse of clinical risk scores to evaluate modifiable and potentially modifiable risk factors for major bleedingHAS-BLEDRating of EvidenceStrong Recommendation,High-Quality Evidence (2010)Class IIa, Level BNot ratedAssociated RecommendationAdopt specific measures to mitigate bleeding risk factorsNot withhold OAC. Identify and correct modifiable bleeding risk factorsFor patients with HAS-BLED ≥3 not withhold OAC and provide regular review and follow-up of the modifiable bleeding risk factors.Table 3 (continued): Baseline Bleeding Risk Evaluation and Associated RecommendationsNHFA/CSANZACCPCCSKHRSYear2018201820182018Bleeding Risk AssessmentIdentification of reversible bleeding risk factorsHAS-BLEDHAS-BLEDHAS-BLEDRating of EvidenceStrong Recommendation,Low-Quality of EvidenceStrong Recommendation,Moderate-Quality of EvidenceStrong Recommendation,High-Quality Evidence (2010)Class I, Level AAssociated RecommendationMinimisation of bleeding risk through treating of reversible risk factorsHAS-BLED ≥3 should not be a reason to withhold OAC. Those patients at higher bleeding risk is warranted for more frequent and regular reviews and follow-upAdopt specific measures to mitigate bleeding risk factorsA high bleeding risk is not a reason to withhold OAC treatment. Modifiable bleeding risk factors should be addressed to reduce bleeding riskLegend: HAS-BLED= Hypertension, Abnormal renal/liver function, Stroke, Bleeding, Labile anticoagulation quality, Elderly, Drugs or alcohol; for other acronyms please see previous tables legends.Table 4: Combination of OAC with Antiplatelet Drugs in patients with Concomitant Cardiac DiseaseCCSESCAPHRSYear201620162017Patients with ACSi) In patients <65 years old and no CHADS2 risk factors 12 months treatment with aspirin and P2Y12 inhibitor (chosen according to risk and implementation of PCI) with indefinite treatment with aspirin if PCI has been performedii) In patients ≥65 years old and CHADS2 ≥1 and no PCI is undertaken clopidogrel 75 mg and OAC for 12 months followed by only OACiii) In patients ≥65 years old and CHADS2 ≥1 and PCI is undertaken ASA 81 mg + clopidogrel 75 mg + OAC for 3/6 months (according to risk) followed by clopidogrel 75 mg + OAC up to 12 months then OACi) In patients not undergoing PCI dual therapy with OAC and aspirin or clopidogrel should be considered up to 12 monthsii) In patients undergoing PCI triple therapy with OAC, aspirin and clopidogrel should be considered from 1 to 6 months on the basis of bleeding risk, followed by dual therapy with aspirin or clopidogreliii) Duration of combination therapy, especially triple therapy, should be kept to the minimum, balancing risk of bleeding and recurrent eventsIn patients with ACS triple therapy can be continued from 1 to 6 months according to bleeding risk (high or low) with dual therapy up to 12 months after the eventRating of Evidencei) Strong Recommendation,High-Quality Evidenceii) Conditional Recommendation,Low-Quality Evidenceiii) Conditional Recommendation,Low-Quality Evidencei) Class IIa, Level Cii) Class IIa, Level Ciii) Class IIa, Level BNot ratedElective PCIi) In patients <65 years and no CHADS2 risk factors indefinite treatment with aspirin + 12 months of treatment with clopidogrel is recommendedii) In patients ≥65 and CHADS2 risk factors OAC + clopidogrel with no aspirin are indicated for 12 months followed by indefinite OACi) In patients undergoing elective PCI, use of triple therapy with OAC, aspirin and clopidogrel should be limited to 1 monthii) Dual therapy with OAC and aspirin or clopidogrel, could be continued up to 6 or 12 months according to bleeding riskIn patients with elective PCI triple therapy should be continued for 1 month, with dual therapy continued up to 6 or 12 months, according to bleeding risk (high or low)Rating of Evidencei) Strong Recommendation,High-Quality Evidenceii) Strong Recommendation,High-Quality Evidencei) Class IIa, Level Bii) Class IIa, Level CNot ratedUse of NOACsWhen OAC indicated a NOAC is preferred over warfarinWhen NOAC is used the lowest recommended dose should be administered together with antiplatelet therapyA NOAC is preferred over warfarinRating of EvidenceNot ratedNot ratedNot ratedTable 4 (continued): Combination of OAC with Antiplatelet Drugs in patients with Concomitant Cardiac DiseaseNHFA/CSANZACCPCCSKHRSYear2018201820182018Patients with ACSi) In patients with ACS or PCI duration of triple therapy should be kept as short as possible to minimize risk of bleeding, still ensuring the coverage of the high risk of recurrent event/stent thrombosisii) After triple therapy, dual therapy with OAC and aspirin 100 mg or clopidogrel 75 mg is recommendedi) In patients with ACS and low bleeding risk, triple therapy is suggested up to 6 months, followed by OAC plus single antiplatelet (preferably clopidogrel) up to 12 monthsii) In patients with ACS and high bleeding risk, triple therapy is suggested from 1 to 3 months, followed by OAC plus antiplatelet (preferably clopidogrel) up to 12 monthsiii) In patients with very high bleeding risk, a strategy with OAC and single antiplatelet (preferably clopidogrel) for 6-9 months is suggestedi) In patients ≤65 years and no CHADS2, use of antiplatelet therapy according to characteristics and extent of disease as directed by other guidelinesii) In patients ≥65 years and CHADS2 ≥1 not undergoing PCI, OAC plus P2Y12 inhibitor (preferably clopidogrel) is indicated for 12 monthsiii) In patients ≥65 years and CHADS2 ≥1 undergoing PCI, OAC, aspirin and clopidogrel are indicated up to 6 months, followed by OAC plus clopidogrel up to 12 monthsNo recommendationRating of Evidencei) Strong Recommendation, Moderate-Quality of Evidenceii) Strong Recommendation, Low-Quality of Evidencei) Weak Recommendation,Low-Quality of Evidenceii) Weak Recommendation,Low-Quality of Evidenceiii) Weak Recommendation,Low-Quality of Evidencei) Not ratedii) Weak Recommendation,Low-Quality of Evidenceiii) Weak Recommendation,Moderate-Quality of Evidence-Elective PCIi) In patients with ACS or PCI duration of triple therapy should be kept as short as possible to minimize risk of bleeding, still ensuring the coverage of the high risk of recurrent event/stent thrombosisii) After triple therapy, dual therapy with OAC and aspirin 100 mg or clopidogrel 75 mg is recommendedi) In patients receiving PCI and low bleeding risk, triple therapy is suggested for 1 month, followed by OAC plus single antiplatelet (preferably clopidogrel) up to 12 monthsii) In patients receiving PCI and high bleeding risk, triple therapy is suggested for 1 month, followed by OAC plus antiplatelet (preferably clopidogrel) up to 6 monthsiii) In patients with very high bleeding risk, a strategy with OAC and single antiplatelet (preferably clopidogrel) for 6 months is suggestedi) In patients ≥65 years and CHADS2 ≥1 receiving PCI without high-risk features, OAC plus clopidogrel is suggested for at least 1 month (BMS) or at least 3 monthsii) In patients ≥65 years and CHADS2 ≥1 receiving PCI with high-risk features, OAC, aspirin and clopidogrel are indicated up to 6 months, followed by OAC plus clopidogrel up to 12 monthsTriple therapy is recommended to be as short as possible, in relation to bleeding risk, unless the risk of stent thrombosis/recurrence would not be too high. After triple therapy, dual therapy with OAC and P2Y12 inhibitor (preferably clopidogrel) should be continued up to 12 months after PCI.Rating of Evidencei) Strong Recommendation, Moderate-Quality of Evidenceii) Strong Recommendation, Low-Quality of Evidencei) Weak Recommendation,Low-Quality of Evidenceii) Weak Recommendation,Low-Quality of Evidenceiii) Weak Recommendation,Low-Quality of Evidencei) Weak Recommendation,Moderate-Quality of Evidenceii) Weak Recommendation,Moderate-Quality of EvidenceNot ratedUse of NOACsNo specific recommendation done.NOACs are indicated equally to VKAsA NOAC is preferred over VKAA NOAC is preferred over VKARating of Evidence-Weak Recommendation,Low-Quality of EvidenceWeak Recommendation,Moderate-Quality of EvidenceNot ratedLegend: ACS= Acute Coronary Syndrome; PCI= Percutaneous Coronary Intervention; for other acronyms please see previous tables legends.Table 5: Oral Anticoagulation Management in Patients Undergoing Ablation or Cardioversion ProcedureCCSESCAPHRSYear201620162017Ablation ProcedureOAC should be continued after AF surgical ablation according to CCS algorithmi) All patients should receive OAC for at least 8 weeks after catheter ablationii) OAC should be continued indefinitely after successful catheter ablation in patients at high risk of strokeiii) Continuation of OAC with VKAs or NOACs during procedure is recommendedi) NOACs can be safe and effective alternatives to VKAs for periprocedural anticoagulationii) OAC should be continued for at least 3 weeks before procedure in patients with at least 48 H of AFiii) OAC should be continued for at least 2 months after ablation, and longer in those patients with high risk of strokeRating of EvidenceStrong Recommendation,Moderate-Quality of Evidencei) Class IIa, Level Bii) Class IIb, Level Ciii) Class IIb, Level B (VKAs) or Level C (NOACs)Not ratedCardioversion ProcedureOAC should be prescribed for 3 weeks before cardioversion and at least 4 weeks after. If AF recurs OAC should be prescribed on the basis of the CCS algorithm. If SR is achieved, decision on continuing OAC after 4 weeks of treatment should be based on risk of stroke and upon expert consultationi) Effective anticoagulation is recommended for at least 3 weeks before cardioversionii) Anticoagulation with heparin or NOAC should be initiated before every cardioversion procedureiii) In patients without stroke risk factors anticoagulation is recommended for 4 weeks. In those at risk of stroke anticoagulation should be continued long-term after procedureiv) Perform TEE is recommended as an alternative to OAC v) If with TEE a thrombus is identified 3 weeks OAC is recommendedi) Anticoagulation is needed 3 weeks before and 4 weeks after cardioversion procedureii) In patients undergoing TEE, if thrombus is identified OAC is needed for at least 4 weeks and repeat TEE to ensure thrombus resolutionii) After cardioversion long-term OAC is needed in patients with high risk of strokeiv) For OAC in patients undergoing cardioversion both VKAs and NOACs can be consideredRating of EvidenceStrong Recommendation,Moderate-Quality of Evidencei) Class I, Level Bii) Class IIa, Level Biii) Class I, Level Biv) Class I, Level Bv) Class I, Level CNot ratedTable 5 (continued): Oral Anticoagulation Management in Patients Undergoing Ablation or Cardioversion ProcedureNHFA/CSANZACCPCCSKHRSYear2018201820182018Ablation ProcedureUninterrupted OAC is recommended for patients undergoing catheter ablationi) OAC with VKA, dabigatran or rivaroxaban is recommended for patients undergoing ablationii) After ablation long-term OAC should be prescribed on the basis of thromboembolic risk profileUse of uninterrupted OAC, either with NOACs or VKAs is recommendedi) Uninterrupted OAC is recommended for patients undergoing catheter ablationii) OAC after ablation should be continued for at least 2 monthsiii) After 2 months, long-term OAC should be decided on patient’s stroke riskRating of EvidenceStrong Recommendation,Moderate-Quality of Evidencei) Weak Recommendation,Low-Quality of Evidenceii) Weak Recommendation,Low-Quality of EvidenceWeak Recommendation,Moderate-Quality of EvidenceNot ratedCardioversion Procedurei) OAC for 3 weeks is recommended (or TEE to document absence of left atrium thrombus) before cardioversion procedureii) OAC is recommended for at least 4 weeks after cardioversion procedurei) In patients with AF for 48H or more OAC with VKAs or NOACs is recommended at least 3 weeks before cardioversion or TEE approach with abbreviated OAC treatmentii) In patients with 48H or less AF or hemodynamic instability, parenteral anticoagulation should be started as soon as possible before procedure and continued for at least 4 weeks iii) After cardioversion, OAC with VKAs or NOACs should be continued for at least 4 weeks. Continuing OAC beyond 4 weeks should be based on general OAC prescription decision makingi) Patients planned to receive cardioversion should receive OAC for 3 weeks before procedureii) 3 weeks OAC treatment can be waived if AF is <12 with no recent stroke or within 12 and 48 hours and there is no substantial stroke riskiii) OAC is recommended to be continued for at least 4 weeksiv) TEE can be considered as an alternative to OACv) Both NOACs and heparin/VKAs strategies can be usedvi) OAC continuation after 4 weeks should be decided on the basis of CCS algorithmi) OAC is recommended for at least 3 weeks before cardioversionii) After procedure OAC is recommended for at least for 4 weeks in patients without stroke risk factors. In patients at risk of stroke, long-term OAC is recommendediii) Anticoagulation with heparin or NOAC should be initiated as soon as possible before every cardioversion procedureiv) If a TEE identify a thrombus in left atrium, effective anticoagulation is recommended for at least 3 weeksRating of Evidencei) Strong Recommendation,Low-Quality of Evidencei) Strong Recommendation,Moderate-Quality of Evidenceii) Weak Recommendation,Low-Quality of Evidenceiii) Strong Recommendation,Moderate-Quality of Evidencei) Strong Recommendation,Moderate-Quality of Evidenceii) Weak Recommendation,Low-Quality of Evidenceiii) Weak Recommendation,Low-Quality of Evidenceiv) Weak Recommendation,Moderate-Quality of Evidencev) Weak Recommendation,Low-Quality of Evidencevi) Strong Recommendation,Moderate-Quality of Evidencei) Class I, Level Bii) Class I, Level Biii) Class IIa, Level Biv) Class I, Level CLegend: SR= Sinus Rhythm; TEE= Trans-Esophageal Echocardiography; for other acronyms please see previous tables legends. ................
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