Askarinejad Amir, Lane Deirdre A, Sadeghipour Parham, Haghjoo Majid, Lip Gregory Y H
Liverpool Centre for Cardiovascular Sciences at University of Liverpool, Liverpool John Moores University and Liverpool Heart & Chest Hospital, Liverpool, UK.
Department of Cardiovascular and Metabolic Medicine, Institute of Life Course and Metabolic Medicine, University of Liverpool, Liverpool, UK.
Eur J Clin Invest. 2025 Sep;55(9):e70082. doi: 10.1111/eci.70082. Epub 2025 Jun 7.
Atrial fibrillation (AF), the most prevalent cardiac arrhythmia, is associated with a significantly increased risk of mortality and morbidity from stroke, thromboembolism and dementia. Recent advances in stroke prevention strategies necessitate an updated approach to management.
Published evidence shows that the Atrial Fibrillation Better Care (ABC) pathway significantly improves stroke prevention outcomes in AF patients, reducing mortality, stroke incidence and bleeding events. Characterisation of AF using the 4S-AF framework helped guide personalised treatment selection and was associated with improved clinical outcomes. For patients unsuitable for anticoagulation, left atrial appendage occlusion has been identified as a viable alternative. Digital health technologies demonstrate increasing utility in early AF detection to enable timely stroke prevention interventions. There is evidence for the dynamic nature of stroke (and bleeding) risk, as well as arrhythmia burden and AF progression over time, in addition to changes in ABC pathway adherence.
Effective stroke prevention in AF requires a comprehensive holistic approach incorporating appropriate risk stratification, guideline-adherent anticoagulation and management of underlying cardiovascular conditions and other comorbidities. The ABC pathway, supported by characterisation using the 4S-AF framework, provides a structured approach to optimise outcomes. Regular reassessment of risk, along with careful selection of anticoagulation strategies, remains crucial. Integration of digital health technologies and structured care pathways shows promise in improving patient outcomes.
心房颤动（AF）是最常见的心律失常，与中风、血栓栓塞和痴呆导致的死亡率和发病率显著增加相关。中风预防策略的最新进展需要更新的管理方法。
已发表的证据表明，心房颤动更佳护理（ABC）路径显著改善了房颤患者的中风预防结果，降低了死亡率、中风发病率和出血事件。使用4S-AF框架对房颤进行特征描述有助于指导个性化治疗选择，并与改善临床结果相关。对于不适合抗凝治疗的患者，左心耳封堵已被确定为一种可行的替代方法。数字健康技术在房颤早期检测中的应用越来越广泛，能够及时进行中风预防干预。有证据表明中风（和出血）风险、心律失常负担以及房颤随时间的进展具有动态性，此外ABC路径的依从性也会发生变化。
房颤的有效中风预防需要一种综合的整体方法，包括适当的风险分层、遵循指南的抗凝治疗以及对潜在心血管疾病和其他合并症的管理。在4S-AF框架特征描述的支持下，ABC路径提供了一种优化结果的结构化方法。定期重新评估风险以及谨慎选择抗凝策略仍然至关重要。数字健康技术与结构化护理路径的整合在改善患者结果方面显示出前景。
