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Brain & Heart Digital tools for stroke and bleeding risk in AF

in AF. Assuming a calculated CHA DS -VASC score, it Ethics approval and consent to participate
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offers four categories of materials according to the patient’s
CHA DS -VASC score of =0, =1, =2, or >3. Each section Not applicable.
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has its own literature and video, with a subsequent decision Consent for publication
aid in Spanish or English. This tool focuses its patient
education on the treatment aspect of AF, whereas the two Not applicable.
aforementioned patient decision aids also provide patient Availability of data
education materials to develop an understanding of AF as
a whole. This tool also requires patients to be aware of what Further educational material can be found at www.
their calculated CHA DS -VASC is before determining AtrialHarmony.org
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which set of information would be most useful for them.
Taken together, these online resources are an important References
component in the physician’s toolkit for shared decision- 1. Tsao CW, Aday AW, Almarzooq ZI, et al. Heart disease and
making, as emphasized in the most recently published stroke statistics-2023 update: A report from the American
guidelines for the management of AF. 30 heart association. Circulation. 2023;147(8):e93-e621.
doi: 10.1161/CIR.0000000000001123
10. Conclusion 2. Colilla S, Crow A, Petkun W, Singer DE, Simon T, Liu X.
The method for estimating stroke and bleeding risks in Estimates of current and future incidence and prevalence of
patients with AF has significantly advanced over the past two atrial fibrillation in the U.S. adult population. Am J Cardiol.
decades. Risk estimation scores have progressively evolved 2013;112(8):1142-1147.
by incorporating biomarkers and non-discrete variables, doi: 10.1016/j.amjcard.2013.05.063
such as electrocardiographic P-wave morphologies, to 3. Schnabel RB, Yin X, Gona P, et al. 50 year trends in atrial
refine predictive accuracy. In recent years, the emergence fibrillation prevalence, incidence, risk factors, and mortality
of digital tools has enhanced physicians’ and patients’ in the Framingham Heart Study: A cohort study. Lancet
ability to engage in evidence-based shared decision- Lond Engl. 2015;386(9989):154-162.
making. Digital tools provide numeric and visual context doi: 10.1016/S0140-6736(14)61774-8
to the output of risk scores, allow for the incorporation of
risk mitigation or augmentation estimates from specific 4. Emdin CA, Wong CX, Hsiao AJ, et al. Atrial fibrillation as
anticoagulation and antiplatelet agents, and improve the risk factor for cardiovascular disease and death in women
ease and accessibility of exporting and sharing decision- compared with men: Systematic review and meta-analysis of
making material. These features have the potential to cohort studies. BMJ. 2016;532:h7013.
facilitate patients’ understanding of their health issues, such doi: 10.1136/bmj.h7013
that patients can become better informed and empowered 5. Lip GYH, Andreotti F, Fauchier L, et al. Bleeding risk
to advocate for their care. assessment and management in atrial fibrillation patients.
Executive Summary of a Position Document from the
Acknowledgments European Heart Rhythm Association [EHRA], endorsed by
None. the European Society of Cardiology [ESC] Working Group
on Thrombosis. Thromb Haemost. 2011;106(6):997-1011.
Funding doi: 10.1160/TH11-10-0690
None. 6. McIntyre WF, Benz AP, Becher N, et al. Direct oral
anticoagulants for stroke prevention in patients with device-
Conflict of interest detected atrial fibrillation: A study-level meta-analysis of
The authors declare that they have no competing interests. the NOAH-AFNET 6 and ARTESiA Trials. Circulation.
2023;149(13):981-988.
Author contributions doi: 10.1161/CIRCULATIONAHA.123.067512

Conceptualization: Jiun-Ruey Hu 7. Agarwal S, Hachamovitch R, Menon V. Current trial-
Writing – original draft: Kyra Dingle, Jeffrey E. Jones, associated outcomes with warfarin in prevention of stroke in
Dhruvil Ashishkumar Patel patients with nonvalvular atrial fibrillation: A meta-analysis.
Writing – review & editing: Camila Trejo-Paredes, Lynda E. Arch Intern Med. 2012;172(8):623-631; discussion 631-633.
Rosenfeld, Jiun-Ruey Hu doi: 10.1001/archinternmed.2012.121

Volume 2 Issue 3 (2024) 17 doi: 10.36922/bh.3068