2017 consensus of the Asia Pacific Heart Rhythm Society on stroke prevention in atrial fibrillation

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.

Use of simplified HAS‐BLED score in patients with atrial fibrillation receiving warfarin

“…15 Labile INR in cHAS-BLED was defined as TTR < 60% in those trials including several standard clinical practice guidelines. 16,18 Previous clinical trials have demonstrated that poor TTR is associated with adverse events including thromboembolism, bleeding, and/or mortality. 7,8 To date, well-controlled VKAs has been used TTR more than 70% as reflect in recommendations of recent clinical practice guidelines.…”

“…7,8 To date, well-controlled VKAs has been used TTR more than 70% as reflect in recommendations of recent clinical practice guidelines. 2,3,18 This trial defined the labile INR by using TTR < 70% as a substitute for those < 60% in cHAS-BLED score because of SAMe-TT 2 R 2 score was proved to predict labile INR < 65%-70% in previous trials. [9][10][11][12][13] Nevertheless, labile INR in cHAS-BLED score in this trial may be different from those in previous HAS-BLED score trials.…”

Stroke and Bleeding Risk Assessments in Patients With Atrial Fibrillation: Concepts and Controversies

“…At present, the majority of clinical guidelines recommend the use of CHA 2 DS 2 -VASc score to aid decision on anticoagulation therapy (20)(21)(22)(23)(24). This tool was refined from the original 2006 Birmingham "National Institute for Health and Care Excellence" stroke risk schema with a specific focus on optimal identification of low-risk individuals and subsequently validated in several large AF cohorts (18,25).…”

Mobile Health (mHealth) technology for improved screening, patient involvement and optimising integrated care in atrial fibrillation: The mAFA (mAF‐App) II randomised trial

“…11 Nonetheless, suboptimal thromboprophylaxis in AF patients is highly prevalent in Asian countries, [12][13][14][15] despite the various guidelines on AF management. 6,[16][17][18] Even moving into the new era of the non-vitamin K antagonist oral anticoagulants (NOACs), many patients remain undertreated in Asia. 19 Non-adherence to AF management guidelines is also common, ranging from 33% to 68% in the Middle East/Africa and Asia, respectively.…”