Division of Research, Kaiser Permanente Northern California, Oakland (A.S.G.).
Department of Health Systems Science, Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, CA (A.S.G.).
Stroke. 2023 Mar;54(3):e75-e85. doi: 10.1161/STROKEAHA.121.038273. Epub 2023 Feb 27.
Atrial fibrillation (AF) is one of the strongest risk factors for ischemic stroke, which is a leading cause of disability and death. Given the aging population, increasing prevalence of AF risk factors, and improved survival in those with cardiovascular disease, the number of individuals affected by AF will continue increasing over time. While multiple proven stroke prevention therapies exist, important questions remain about the optimal approach to stroke prevention at the population and individual patient levels. Our report summarizes the National Heart, Lung, and Blood Institute virtual workshop focused on identifying key research opportunities related to stroke prevention in AF. The workshop reviewed major knowledge gaps and identified targeted research opportunities to advance stroke prevention in AF in the following areas: (1) improving risk stratification tools for stroke and intracranial hemorrhage; (2) addressing challenges with oral anticoagulants; and (3) delineating the optimal roles of percutaneous left atrial appendage occlusion and surgical left atrial appendage closure/excision. This report aims to promote innovative, impactful research that will lead to more personalized, effective use of stroke prevention strategies in people with AF.
心房颤动（AF）是缺血性卒中的最强危险因素之一，而缺血性卒中是导致残疾和死亡的主要原因。鉴于人口老龄化、AF 风险因素的流行率增加以及心血管疾病患者生存率的提高，受 AF 影响的人数将随着时间的推移继续增加。虽然存在多种经过验证的卒中预防疗法，但在人群和个体患者层面上，关于卒中预防的最佳方法仍存在重要问题。我们的报告总结了美国国立心肺血液研究所（National Heart, Lung, and Blood Institute）的一次虚拟研讨会，该研讨会重点关注确定与 AF 相关的卒中预防相关关键研究机会。该研讨会审查了主要的知识空白，并确定了有针对性的研究机会，以在以下领域推进 AF 中的卒中预防：（1）改善卒中和颅内出血的风险分层工具；（2）解决口服抗凝剂的挑战；（3）明确经皮左心耳封堵和手术左心耳切除/结扎的最佳作用。本报告旨在促进创新性、有影响力的研究，从而导致更个性化、更有效地使用 AF 患者的卒中预防策略。
