Chao Tze-Fan, Potpara Tatjana S, Lip Gregory Y H
Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.
Institute of Clinical Medicine, and Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
Lancet Reg Health Eur. 2024 Feb 1;37:100797. doi: 10.1016/j.lanepe.2023.100797. eCollection 2024 Feb.
Stroke prevention is central to the management of patients with atrial fibrillation (AF) which has moved towards a more holistic or integrative care approach. The published evidence suggests that management of AF patients following such a holistic approach based on the Atrial fibrillation Better Care (ABC) pathway is associated with a lower risk of stroke and adverse events. Risk assessment, re-assessment and use of direct oral anticoagulants (DOACs) are important for stroke prevention in AF. The stroke and bleeding risks of AF patients are not static and should be re-assessed regularly. Bleeding risk assessment is to address and mitigate modifiable bleeding risk factors, and to identify high bleeding risk patients for early review and follow-up. Well-controlled comorbidities and healthy lifestyles also play an important role to achieve a better clinical outcome. Digital health solutions are increasingly relevant in the diagnosis and management of patients with AF, with the potential to improve stroke prevention. In this review, we provide an update on stroke prevention in AF, including importance of holistic management, risk assessment/re-assessment, and stroke prevention for special AF populations. Evidence-based and structured management of AF patients would reduce the risk of stroke and other adverse events.
预防中风是心房颤动(AF)患者管理的核心,目前已朝着更全面或综合的护理方法发展。已发表的证据表明,按照基于房颤更佳护理(ABC)路径的这种全面方法对房颤患者进行管理,与较低的中风和不良事件风险相关。风险评估、重新评估以及直接口服抗凝剂(DOACs)的使用对于房颤的中风预防很重要。房颤患者的中风和出血风险并非一成不变,应定期重新评估。出血风险评估旨在解决和减轻可改变的出血风险因素,并识别出血风险高的患者以便早期复查和随访。良好控制的合并症和健康的生活方式对于取得更好的临床结果也起着重要作用。数字健康解决方案在房颤患者的诊断和管理中越来越重要,具有改善中风预防的潜力。在本综述中,我们提供了房颤中风预防的最新情况,包括全面管理的重要性、风险评估/重新评估以及特殊房颤人群的中风预防。基于证据和结构化的房颤患者管理将降低中风和其他不良事件的风险。