2021 Focused Update Consensus Guidelines of the Asia Pacific Heart Rhythm Society on Stroke Prevention in Atrial Fibrillation: Executive Summary

Abstract

The consensus of the Asia Pacific Heart Rhythm Society (APHRS) on stroke prevention in atrial fibrillation (AF) has been published in 2017 which provided useful clinical guidance for cardiologists, neurologists, geriatricians, and general practitioners in the Asia-Pacific region. In these years, many important new data regarding stroke prevention in AF were reported. The practice guidelines subcommittee members comprehensively reviewed updated information on stroke prevention in AF, and summarized them in this 2021 focused update of the 2017 consensus guidelines of the APHRS on stroke prevention in AF. We highlighted and focused on several issues, including the importance of the AF Better Care pathway, the advantages of non-vitamin K antagonist oral anticoagulants (NOACs) for Asians, the considerations of use of NOACs for Asian AF patients with single one stroke risk factor beyond gender, the role of lifestyle factors on stroke risk, the use of oral anticoagulants during the “coronavirus disease 2019” pandemic, etc. 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.

Growth Differentiation Factor 15 in Cardiovascular Diseases: Predicting Bleeding after Cardiac Surgery and Beyond That!

“…may discourage the incorporation of GDF-15 in guidelines related to antithrombotic therapy, where simplicity and practicality for decision making should be prioritized. 32 33 34…”

“…may discourage the incorporation of GDF-15 in guidelines related to antithrombotic therapy, where simplicity and practicality for decision making should be prioritized. [32][33][34] Moreover, a limitation of GDF-15 is the lack of real-world studies given that most of the evidence is derived from randomized clinical trials. This is relevant for the particular issue of bleeding since one recent study suggested that differences in patient characteristics and risk profiles of patients from observational studies are important contrib-utors to the differences in bleeding outcomes between clinical practice and randomized trials.…”

Relation of the ‘Atrial Fibrillation Better Care (ABC) Pathway’ to the Quality of Anticoagulation in Atrial Fibrillation Patients Taking Vitamin K Antagonists

“…This is proposed in the Atrial Fibrillation Better Care (ABC) pathway, where ‘A’ refers to ‘Avoid stroke’; ‘B’ refers to ‘Better symptom management’ and ‘C’ refers to ‘Cardiovascular and comorbidity risk reduction’ [ 7 ]. Recently, the 2020 European Society of Cardiology guidelines on the management of AF, as well as other international guidelines, have recognized this need for a more integrated care, by including for the first time the ABC pathway as a simplified and concise approach that integrates the care of AF patients across various levels of healthcare professionals and between specialties [ 8 , 9 , 10 ].…”

Effects of the Atrial Fibrillation Better Care Pathway on Outcomes Among Clinically Complex Chinese Patients With Atrial Fibrillation With Multimorbidity and Polypharmacy: A Report From the ChiOTEAF Registry

“…The importance and evident benefits of a well‐rounded holistic and integrated approach to evaluation, characterization, and management of atrial fibrillation (AF) have been emphasized in recent guidelines. 1 , 2 , 3 Standardizing holistic management through protocolization and implementation of framework models can lead to improved patient care. 4 , 5 The Atrial Fibrillation Better Care (ABC) pathway promotes such an integrated approach to AF management 6 : (A) avoid stroke; (B) better symptom control, with patient‐centered symptom‐guided decisions on rate or rhythm control; and (C) cardiovascular risk factor and comorbidity optimization, including lifestyle changes.…”