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Brain & Heart

REVIEW ARTICLE
Digital tools and scores for estimating the risk of

stroke and bleeding in atrial fibrillation

Kyra Dingle 1† , Jeffrey E. Jones 1† , Dhruvil Ashishkumar Patel 2 ,
3
Camila Trejo-Paredes , Lynda E. Rosenfeld 3 , and Jiun-Ruey Hu *
3,4
1 School of Medicine, University of California Irvine, Irvine, California, United States of America
2 Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, United
States of America
3 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine,
New Haven, Connecticut, United States of America
4 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA,
United States of America

Abstract
Atrial fibrillation (AF) is a significant risk factor for cardioembolic stroke; however,
therapeutic anticoagulation for stroke prevention in patients with AF also increases
the risk of bleeding. Over the past two decades, extensive efforts have focused on
refining patient stratification into risk categories to guide the selection of anticoagulant
therapy. Various scores have been developed to estimate stroke risk in patients with
AF, including CHADS , Framingham, CHA DS -VASc, ATRIA, ABC, GARFIELD-AF, and
2
2
2
† These authors contributed equally IMRS-VASc, with CHA DS -VASc being the most widely utilized. Similarly, scores such
to this work. 2 2
as HEMORR HAGES, HAS-BLED, ORBIT, ATRIA, GARFIELD-AF, and the newly introduced
2
*Corresponding author: DOAC are utilized to estimate bleeding risk, with HAS-BLED being predominant. In
Jiun-Ruey Hu
(jiun-ruey.hu@yale.edu) recent years, numerous digital tools have been developed to assist physicians and
patients in visualizing the risk of stroke and bleeding in an interactive manner, to
Citation: Dingle K, Jones JE, strengthen the use of evidence-based medicine, and to facilitate shared decision-
Patel DA, Trejo-Paredes C,
Rosenfeld LE, Hu JR. Digital making. These tools include the American College of Cardiology’s AnticoagEvaluator
tools and scores for estimating app, Mayo Clinic Anticoagulation Choice Decision Aid, Stroke Prevention in Atrial
the risk of stroke and bleeding in Fibrillation Risk Tool (SPARCtool), GARFIELD-AF Risk Calculator, and CardioSmart
atrial fibrillation. Brain & Heart.
2024;2(3):3068. Atrial Fibrillation and Bleeding Risk Calculator. This review explores the evolution of
doi: 10.36922/bh.3068 these risk scores, evaluating their merits and drawbacks while highlighting common
Received: March 1, 2024 variables across multiple risk scores. In addition, it describes the landscape of novel
digital tools designed for decision-making, offering insights from the perspective of
Accepted: May 29, 2024
physician users.
Published Online: August 7, 2024
Copyright: © 2024 Author(s). Keywords: Atrial fibrillation; Anticoagulation; Bleeding; Stroke; Digital tools; Risk score
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution
License, permitting distribution,
and reproduction in any medium, 1. Introduction
provided the original work is
properly cited. Atrial fibrillation (AF) is the most common arrhythmia in adults, with an estimated
1
Publisher’s Note: AccScience global prevalence of 50 million in 2020. In the United States (US) alone, the prevalence
Publishing remains neutral with of AF is projected to increase to 12.1 million in 2030 from 5.2 million in 2010, and
regard to jurisdictional claims in
published maps and institutional the incidence of AF is projected to increase to 2.6 million in 2030 from 1.2 million in
2,3
affiliations. 2010. AF not only contributes significantly to mortality but also to morbidity related to
Volume 2 Issue 3 (2024) 1 doi: 10.36922/bh.3068