Materiały źródłowe

• #1 Management of Atrial Fibrillation: Guidelines From the American College of Cardiology and American Heart Association | AAFP

  https://www.aafp.org/pubs/afp/issues/2025/0200/practice-guidelines-atrial-fibrillation.html

  Percutaneous occlusion of the left atrial appendage reduces stroke risk and mortality with similar effectiveness as warfarin. […] Surgical exclusion of the left atrial appendage during cardiac surgery reduces stroke risk with continued anticoagulation. […] Atrial fibrillation (AF) is expected to impact 12 million people by 2030 and increase mortality risk by at least 1.5 times.

• #1 Atrial Fibrillation and Stroke Prevention | IntechOpen

  https://www.intechopen.com/online-first/1191078

  Atrial fibrillation is the most common sustained arrhythmia encountered in adults and is associated with an increased morbidity and mortality due to both causing and contributing to an increase in the risk of stroke and heart failure. […] The chapter also addresses the assessment of stroke risk in AF patients and explores the options for anticoagulation and left atrial appendage closure. […] The third main goal of management is the prevention of thromboembolic events through prophylactic measures, as AF predisposes individuals to thrombus formation, which can lead to serious adverse events including stroke. […] For stable patients with AF, assess thromboembolic risk using the CHA2DS2-VASc score, and consider the initiation of anticoagulation. […] The decision of starting anticoagulation should be shared with the informed patient. The benefit should be weight against the risk of bleeding.

• #1 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20231130/New-guideline-emphasizes-prevention-early-rhythm-control-for-atrial-fibrillation.aspx

  The updated guideline calls for a stronger, more prescriptive focus on healthy lifestyle habits to prevent or lessen the burden of AFib, as well as early and more aggressive rhythm control in general, including upgraded recommendations for catheter ablation as first line therapy to prevent disease progression. […] There is clearer focus on risk factor modification – for example, weight loss and obesity prevention, physical activity, smoking cessation, limiting alcohol, and controlling blood pressure and other comorbidities – to help prevent AFib or ameliorate any recurrences or worsening of the disease. […] The new guideline reinforces the urgent need to approach AFib as a complex cardiovascular condition that requires disease prevention, risk factor modification, as well as optimizing therapies and patients’ access to care and ongoing, long-term management.

• #1 Life’s Simple 7 Approach to Atrial Fibrillation Prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6533817/

  Atrial fibrillation (AF) is the most commonly encountered arrhythmia in clinical practice. It constitutes a major public health problem, with total related annual expenses estimated at $6.65 billion. […] Improvement of overall cardiovascular health as defined by LS7 may substantially reduce AF risk. […] Recent data suggests reduced risk of AF with favorable LS7 score. […] Thus, existing evidence suggest a beneficial effect of BP control, specifically lowering systolic BP, as maybe an important factor in AF prevention. […] Diabetes Mellitus (DM) is a well-established risk factor for AF. […] There is a clear epidemiological association between obesity and AF. There is also substantial evidence that weight control may reduce the increasing incidence of AF, making it an important component for the primary prevention of AF.

• #1 10 ways to stop and prevent and AFib episode

  https://www.medicalnewstoday.com/articles/320285

  Methods to help stop an atrial fibrillation (AFib) episode include stress management techniques, such as deep breathing and muscle relaxation. Treating the underlying cause, dietary changes, and exercising can also help prevent episodes. […] The regular practice of stress management techniques, such as focused deep breathing, muscle relaxation, and yoga could reduce the risk of an AFib episode. […] Recent guidelines suggest that aerobic exercise may be particularly beneficial in reducing AFib. […] This research suggests that avoiding or limiting alcohol may be one way to stop an AFib episode. […] If a person smokes, taking steps to reduce or stop smoking may help with managing AFib. […] Following a heart healthy diet may be particularly beneficial for people with AFib. […] Current guidelines recommend weight loss for people with AFib and overweight or obesity. This can result in a reduction in arrhythmia symptoms, how frequently they occur, and the related burden.

• #1 Atrial fibrillation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624

  Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation (AFib). Here are some basic heart-healthy tips: […] Control high blood pressure, high cholesterol and diabetes. […] Don’t smoke or use tobacco. […] Eat a diet that’s low in salt and saturated fat. […] Exercise at least 30 minutes a day on most days of the week unless your health care team says not to. […] Get good sleep. Adults should aim for 7 to 9 hours daily. […] Maintain a healthy weight. […] Reduce and manage stress.

• #1 Life’s Simple 7 Approach to Atrial Fibrillation Prevention

  https://pmc.ncbi.nlm.nih.gov/articles/PMC6533817/

  Overall, physical activity may have a U-shaped relationship with the risk of AF in athletes and non-athletes, and a non-linear relationship is observed between physical fitness and the risk of AF. […] Current data suggests potential protective effect of EVOO for AF prevention, however future research on the clinical significance of these associations is needed. […] Smoking cessation was one of the risk modification measures of ARREST AF trial which showed the reduction of AF incidence. […] There is evidence that most of the components of LS7 are risk factors for development of AF and are both preventable and modifiable. […] Thus, by achieving optimal cardiovascular health profile, as defined by LS7, it is possible to substantially reduce AF risk.

• #1 Lifestyle Strategies for Atrial Fibrillation | American Heart Association

  https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-and-prevention-of-atrial-fibrillation/prevention-strategies-for-atrial-fibrillation-afib-or-af

  To reduce your risk for the onset of atrial fibrillation, also called AFib or AF, maintaining a heart-healthy lifestyle is always your best option. […] If you have been diagnosed with AFib, take medications if they are prescribed for you. Also get proper treatment and management of your condition so that you can reduce the risk of AFib’s harmful consequences. […] These actions help lower the risk for heart disease and keep your circulatory system in the best condition: Get regular physical activity, Eat a heart-healthy diet low in salt, saturated fats, trans fats and cholesterol, Manage high blood pressure, Avoid excessive amounts of alcohol and caffeine, Don’t smoke, Control cholesterol, Maintain a healthy weight. […] Treatment for AFib is imperative to reduce your risk for stroke. […] The good news is that you can greatly reduce by making healthy changes and treating your medical conditions as instructed.

• #1 Atrial Fibrillation: Prevention, Prediction, and Risk Reduction

  https://www.patientcareonline.com/view/atrial-fibrillation-prevention-prediction-and-risk-reduction

  Omega-3 fatty acids may help reduce the risk of atrial fibrillation in postcardiac surgery patients. […] Therapy with omega-3 fatty acid (or polyunsaturated fatty acids or PUFA) significantly reduced the risk of developing atrial fibrillation (AF). […] This significant difference suggests that PUFA therapy could reduce the risk of AF in these post-cardiac surgery patients. […] Echocardiographic studies may help predict future AF. […] An old gout medication may help patients reduce the risk of AF in patients with CHF. […] The incidence of AF was 13% lower in the group that received allopurinol.

• #1 Atrial Fibrillation: Symptoms, Causes, and Treatments

  https://patient.info/heart-health/atrial-fibrillation-leaflet

  Atrial fibrillation can’t always be prevented, but there are things that you can to which reduce the risk of it happening. These include: […] Limit the amount of alcohol you drink, and avoid binge drinking. Alcohol is strongly linked to atrial fibrillation. Heavy alcohol use (especially binge drinking) is commonly-recognised amongst doctors as a trigger for episodes of AF, but more recent research has shown that drinking even a modest amount of alcohol regularly increases the risk of AF. […] Avoid, or stop, smoking. Smoking tobacco increases the risk of developing AF. […] Avoid using drugs such as cocaine, cannabis, methamphetamines, and opiates. […] Stay physically active and exercise regularly. Aim to get at least 150 minutes of moderate-intensity exercise each week (which can be broken down into smaller chunks). Exercise has many health benefits. It can help to prevent atrial fibrillation and is also good for people who already have atrial fibrillation.

• #1 Atrial Fibrillation: Symptoms, Causes, and Treatments

  https://patient.info/heart-health/atrial-fibrillation-leaflet

  Maintain a healthy weight. Having overweight or obesity is a risk factor for AF. […] There is no need to give up caffeine. Research has shown that caffeine is not linked to developing atrial fibrillation, and drinking a moderate amount of coffee and tea may actually be good for the heart. However, some people are sensitive to caffeine and find that it gives them palpitations – if that’s the case, it is a good idea to minimise the amount of caffeine-containing food or drink you have.

• #1 Lifestyle Changes for Atrial Fibrillation & Atrial Flutter | NYU Langone Health

  https://nyulangone.org/conditions/atrial-fibrillation-atrial-flutter/treatments/lifestyle-changes-for-atrial-fibrillation-atrial-flutter

  People who have atrial fibrillation (AFib) and atrial flutter are at increased risk for conditions that affect the heart, such as high blood pressure, coronary artery disease, and heart attack. By following a heart-healthy lifestyle, you can limit experiences that trigger AFib or atrial flutter, as well as reduce your risk of heart disease. […] Heart specialists at NYU Langones Heart Rhythm Center recommend the following lifestyle changes for atrial flutter and atrial fibrillation management. […] A healthy diet and exercise play a major role in preventing heart disease and reducing symptoms related to AFib and atrial flutter. […] Limiting caffeine and alcohol can reduce symptoms of arrhythmia. […] If you smoke or use tobacco products, its recommended that you stop. […] To ease symptoms of sleep apnea, sleep experts may recommend reducing or eliminating alcohol and sedative use, changing your sleep position, or using a mouth guard or continuous positive airway pressure (CPAP) device that keeps the airway open while you sleep. […] Studies have shown that too much stress can raise your blood pressure and trigger AFib or atrial flutter. […] Exercise can help you lose weight and reduce high blood pressure. Taking a brisk 30-minute walk every day can improve your heart health and reduce the risk of triggering an arrhythmia.

• #1 Atrial Fibrillation Prevention | Kansas City Heart Rhythm Institute

  https://kcheartrhythm.com/services/atrial-fibrillation-prevention.dot

  Risk factors include: Hypertension (blood pressure), Obesity and weight management, Obstructive sleep apnea. […] Risk factor management and lifestyle changes: Nutrition, Exercise (being physically active), Getting enough rest, Stress management, Reducing or eliminating alcohol consumption, cigarette smoking and drug abuse.

• #1 Risk Factor Management in Atrial Fibrillation | AER Journal

  https://www.aerjournal.com/articles/risk-factor-management-atrial-fibrillation?language_content_entity=en

  Atrial fibrillation (AF) is the most common clinical arrhythmia and is associated with increased morbidity and mortality. […] Beyond oral anticoagulant therapy, rate and rhythm control, therapy targeting risk factors and underlying conditions is an emerging AF management strategy that warrants better implementation in clinical practice. […] It discusses evidence for the early management of underlying conditions to improve AF outcomes. […] Targeting these risk factors and underlying conditions as early as possible ideally before AF becomes clinically manifest would not only prevent or reverse atrial remodelling and thus prevent or limit AF progression but also improve the underlying conditions themselves and in turn reduce strokes and other cardiovascular adverse events. […] Therefore, it is not surprising that inpatient AF care accounts for more than two-thirds of the annual direct costs of AF and is the major cost driver.

• #1 Atrial Fibrillation Treatment and Prevention

  https://www.everydayhealth.com/atrial-fibrillation/guide/treatment/

  Atrial fibrillation (AF or afib) involves abnormal electrical activity in the upper chambers (atria) of your heart, which causes the organ to beat quickly and irregularly. […] Its important to get diagnosed and treated for atrial fibrillation as soon as possible, before the condition causes dangerous complications like blood clots, heart disease, or a stroke. […] The goals of treatment for atrial fibrillation are to restore your hearts natural rhythm and rate, help prevent blood clots, and reduce your stroke risk. Treatment should also involve addressing any underlying health problems that have caused or contributed to the condition. […] Many of the same lifestyle changes that are often recommended to treat afib may also help prevent the condition. […] Helpful steps may include: Being physically active, Maintaining a healthy weight, Following a heart-healthy diet, Limiting alcohol and caffeine, Managing stress, Not smoking, Treating or controlling conditions that may contribute to afib, such as diabetes, thyroid disease, high blood pressure, or high cholesterol.

• #1 Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3006380/

  Atrial Fibrillation (AF) is the most common arrhythmia occurring after cardiac surgery. Its incidence varies depending on type of surgery. Postoperative AF may cause hemodynamic deterioration, predispose to stroke and increase mortality. Effective treatment for prophylaxis of postoperative AF is vital as reduces hospitalization and overall morbidity. Beta – blockers, have been proved to prevent effectively atrial fibrillation following cardiac surgery and should be routinely used if there are no contraindications. Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects. Amiodarone is useful when beta-blocker therapy is not possible or as additional prophylaxis in high risk patients. Other agents such as magnesium, calcium channels blocker or non-antiarrhythmic drugs as glycose-insulin – potassium, non-steroidal anti-inflammatory drugs, corticosteroids, N-acetylcysteine and statins have been studied as alternative treatment for postoperative AF prophylaxis.

• #1 Primary prevention of atrial fibrillation with beta-blockers in patients with end-stage renal disease undergoing dialysis | Scientific Reports

  https://www.nature.com/articles/srep17731

  Current evidence suggests that beta-blocker lower the risk of development of atrial fibrillation (AF) and in-hospital stroke after cardiac surgery. […] In conclusion, beta-blockers seem effective in the primary prevention of AF in ESRD patients. Hence, beta-blockers may be the target about upstream treatment of AF. […] Beta-blockers administration is the most widely used prophylactic strategy of POAF based on numerous studies showing benefit, ease of use and cost consideration. […] The present guideline also recommends preoperative or early postoperative administration of beta-blockers in patients without contraindication in order to reduce the incidence of AF and clinical sequels after coronary bypass surgery. […] The main finding from this nationwide database retrospective study of patients with ESRD is the protective effect of beta-blocker against development of AF, with an HR around 0.4 to 0.6 if the patient had received beta-blocker. […] Therefore, beta-blocker might potentially be an effective therapy for primary prevention in patients with ESRD. […] In patients with ESRD receiving replacement therapy, beta-blocker usage is associated with appeared to be effective in the primary prevention of AF.

• #1 Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3006380/

  In conclusion, b-blockers should routinely be used as first choice for the prophylaxis of AF in all patients undergoing cardiac surgery, unless otherwise contraindicated (Grade A recommendation based on level 1a studies). Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects (Grade A recommendation based on level 1b studies). Amiodarone should be used for prophylaxis of AF in all patients undergoing cardiac surgery in which b-blocker therapy is not possible (Grade A recommendation based on level 1a and1b studies). In high-risk patients receiving b-blocker therapy for prophylaxis of AF, amiodarone may also be used as additional prophylaxis with an acceptably low incidence of complications.

• #1

  https://link.springer.com/article/10.1007/s11886-005-0093-4

  Atrial fibrillation (AF) is the most common cardiac arrhythmia seen after cardiac surgery. It is associated with prolongation of hospital stay, postoperative complications, stroke, mortality, and increased hospital cost. Several prevention strategies have been proven effective in reducing postoperative AF; in addition, active prevention of postoperative AF is associated with a decrease in the length of hospital stay and a reduction trend in hospital costs. […] Adequate oral anticoagulation may be indicated for a limited period of time. […] This is a meta-analysis of available interventions on prevention of postoperative AF after cardiac surgery. […] Most recent meta-analysis of available interventions on prevention of postoperative AF after cardiac surgery. […] The preliminary results of this study suggest that preoperative statin use is associated with a reduction in occurrence of AF after cardiac surgery.

• #1 Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials | EuroIntervention

  https://eurointervention.pcronline.com/article/posterior-pericardiotomy-for-the-prevention-of-atrial-fibrillation-after-cardiac-surgery-a-systematic-review-and-meta-analysis-of-25-randomised-controlled-trials

  Atrial fibrillation (AF) associated with postoperative pericardial effusion is the most commonly reported adverse event after cardiac surgery. […] We aimed to determine the role of posterior pericardiotomy in preventing postoperative AF (POAF). […] The overall incidence rate of POAF was 11.7% in the PP group compared with 23.67% in the no PP or control group, with a significant decrease in the risk of POAF following PP (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.38-0.61). […] PP is an effective intervention for reducing the risk of POAF after cardiac surgery. […] The pathophysiology behind AF post-cardiac surgery is multi-faceted, and multiple aetiologies have been identified. […] Prophylactic beta blockers have been shown to control the catecholamine surge in the perioperative period, demonstrating a significant decrease in the rate of postoperative AF.

• #1 Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials | EuroIntervention

  https://eurointervention.pcronline.com/article/posterior-pericardiotomy-for-the-prevention-of-atrial-fibrillation-after-cardiac-surgery-a-systematic-review-and-meta-analysis-of-25-randomised-controlled-trials

  As PPE has been shown to be associated with an increased incidence of postoperative AF, the drainage of pericardial blood or effusion will consequently decrease the incidence of the associated AF. […] Multiple randomised controlled trials have tested the efficacy of performing a posterior pericardiotomy (PP) after cardiac surgery as a prophylactic measure to prevent postoperative AF (POAF). […] Our study included 25 trials of 4,467 patients comparing PP with the control group (no PP). […] We found that the PP group was superior to the control group regarding the following outcomes: POAF, SVT, early and pericardial effusion, pericardiac tamponade, and hospital stay. […] Our findings suggest that PP can dramatically decrease pericardial effusion in patients after CABG, with both early and late pericardial effusion being much less common in the PP group compared to the control group.

• #1 Stroke Prevention in Atrial Fibrillation Patients: A Systematic Review Update | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/stroke-afib-update/research-protocol

  This systematic review is an update of an earlier report published in 2013 which evaluated questions related to stroke prevention in patients with atrial fibrillation (AF) and atrial flutter. […] Management of AF involves three distinct areas, namely, rate control, rhythm control, and prevention of thromboembolic events. This review will focus on prevention of thromboembolic events. […] Patients with AF have a five-fold increased risk of stroke, and it is estimated that up to 25 percent of all strokes in the elderly are a consequence of AF. […] The 2014 AHA/ACC/HRS Guideline for the Management of Patients with Atrial Fibrillation recommends the use the CHADS2-VASc score to estimate the stroke risk, and oral anticoagulation is indicated for patients with a score 2, and it should be considered for patients with a score of 1 (i.e., with one risk factor).

• #1 Atrial Fibrillation Guidelines: Atrial Fibrillation Classification, Stroke Risk Assessment, Antithrombotic Therapy

  https://emedicine.medscape.com/article/151066-guidelines

  Guidelines have been issued by the following organizations for prevention of stroke in atrial fibrillation (AF) patients: […] All major guidelines note that one of the major management decisions in AF is determining the risk of stroke and the appropriate anticoagulation regimen for low-, intermediate-, and high-risk patients. […] The AHA/ACC/HRS further recommends that antithrombotic therapy should be based on the risk of thromboembolism irrespective of whether the AF pattern is paroxysmal, persistent or permanent. […] In 2014, the American Heart Association (AHA) also issued joint guidelines with the American Stroke Association (ASA) for the primary prevention of stroke, which included specific recommendations for stroke prevention in patients with AF. […] The main advantage of the CHA2DS2-VASc score (range, 0-9) is that it provides significantly improved risk prediction for individuals at low to moderate risk compared with the CHADS2 (scores of 0 or 1), particularly for elderly women.

• #1 Stroke Prevention in Atrial Fibrillation | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/stroke-atrial-fibrillation/research

  Oral anticoagulation with vitamin K antagonists (VKAs) has long been the gold standard therapy for stroke prevention in nonvalvular atrial fibrillation (AF). […] Limitations in monitoring and compliance of VKAs have fueled the development of new antithrombotic strategies, devices, and oral anticoagulants, including oral direct thrombin inhibitors and factor Xa inhibitors. […] Data suggest that the continuous CHADS2 (Congestive heart failure, Hypertension, Age 75, Diabetes mellitus, prior Stroke/transient ischemic attack [2 points]) and continuous CHA2DS2-VASc (Congestive heart failure/left ventricular ejection fraction 40%, Hypertension, Age 75 [2 points], Diabetes mellitus, prior Stroke/transient ischemic attack/thromboembolism [2 points], Vascular disease, Age 6574, Sex category female) scores have the greatest discrimination for stroke risk (c-statistic 0.71 [95% confidence interval (CI), 0.66 to 0.75], and c-statistic 0.70 [95% CI 0.66 to 0.75], respectively; low strength of evidence for both scores) and that the HAS-BLED (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly [65 years], Drugs/alcohol concomitantly) score has the greatest discrimination for bleeding risk (moderate strength of evidence).

• #1

  https://www.healio.com/news/cardiology/20231130/new-atrial-fibrillation-guideline-highlights-early-rhythm-control-prevention-strategies

  The guideline recommends clinicians consider moving beyond the CHA2DS2-VASc clinical risk score for prediction of stroke and systemic embolism, noting that clinicians consider other risk variables or other clinical risk scores to help inform treatment decisions for patients with an intermediate annual risk score where there are uncertainties about the benefit of anticoagulation. […] For select patients with AF, the guideline recommends catheter ablation with a class 1 indication as first-line therapy. […] Additionally, catheter ablation of AF is recommended as a class 1 indication for appropriate patients with HF with reduced ejection fraction. […] The authors also upgraded left atrial appendage occlusion (LAAO) to a class 2a recommendation, noting additional data now are available on the safety and efficacy of LAAO devices. […] The new guideline gives clinicians flexibility to use other predictive tools, and we hope this will also enhance communication and shared decision-making with patients.

• #1 Stroke prevention strategies in high-risk patients with atrial fibrillation | Nature Reviews Cardiology

  https://www.nature.com/articles/s41569-020-00459-3

  Effective stroke prevention with oral anticoagulation (OAC) is the cornerstone of the management of patients with atrial fibrillation. The use of OAC reduces the risk of stroke and death. […] International guidelines for the management of AF recommend that OAC should be considered in all patients with AF and risk factors for stroke. […] In patients at high risk of stroke and bleeding, a tailored approach is needed to achieve a positive net clinical benefit of applied therapies (balancing the risks and the benefits of a treatment). […] Maintaining a good quality of anticoagulation (with a good time in therapeutic range for those receiving warfarin or label-adherent dosing if receiving non-vitamin K antagonist oral anticoagulants) and mitigating modifiable risk factors for bleeding can positively affect outcomes in patients with AF. […] Left atrial appendage closure can be considered as an alternative strategy for stroke prevention in patients with AF who have contraindications to OAC therapy.

• #1 Stroke Prevention in Atrial Fibrillation Patients: A Systematic Review Update | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/stroke-afib-update/research-protocol

  Much of the focus of AF management has been on treatment strategies for stroke prevention. Antithrombotic therapies are the mainstays used to prevent thromboembolic events in patients with AF. […] Systemic anticoagulation has been shown to reduce the risk of stroke by two-thirds. […] Following recent recommendations from the European Society of Cardiology on the management of AF, antiplatelets are no longer recommended for stroke prevention in AF. […] There are several areas of insufficient evidence and uncertainty within the field of stroke prevention in patients with AF: […] The safety and effectiveness of DOACs is unclear in patients not included or not well-represented in randomized clinical trials (e.g., patients with moderate to severe chronic kidney disease (CKD) [eGFR60], valvular heart disease, extremes of BMI, older age, women, multiple comorbidities, and a history of bleeding or frequent falls). […] The relative safety and effectiveness of DOACs as compared to left atrial appendage (LAA) occlusion devices is uncertain.

• #1 7. Anticoagulant Therapy for Atrial Fibrillation | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anticoagulation-for-individuals-with-stroke-and-atrials-fibrillation

  Patients with ischemic stroke or transient ischemic attack and atrial fibrillation should receive oral anticoagulant therapy for secondary stroke prevention [Evidence Level A]. […] For patients with an ischemic stroke or transient ischemic attack and atrial fibrillation, oral anticoagulant therapy is strongly recommended [Evidence Level A]. It is recommended over acetylsalicylic acid [Evidence Level A] and dual antiplatelet therapy [Evidence level B]. […] For patients with ischemic stroke or transient ischemic attack and atrial fibrillation who are unable to take oral anticoagulant therapy (DOAC or warfarin), acetylsalicylic acid alone is recommended unless also contraindicated [Evidence Level A]. […] For ischemic stroke or transient ischemic attack in patients with non-valvular atrial fibrillation who cannot receive long-term oral anticoagulant therapy, a left atrial appendage occlusion procedure may be considered [Evidence Level B].

• #1 Atrial Fibrillation and Stroke Prevention | IntechOpen

  https://www.intechopen.com/online-first/1191078

  For most patients with AF and an indication for anticoagulation, we recommend a direct oral anticoagulant (DOAC), rather than a vitamin K antagonist, for their safety, efficacy, and ease of use. […] Long-term AF is a dynamic disease with changing risk for stroke. Disease progression, changing patient characteristics, and risk versus benefit prompt clinicians to reevaluate the need for and choice of stroke risk reduction therapy at periodic intervals. […] In patients who have history of major bleed, where long-term anticoagulation is contraindicated, clinicians may recommend a left atrial appendage closure (LAAC). […] Mechanical preventive measures like surgical exclusion of the left atrial appendage (LAA) and percutaneous LAA closure (LAAC) have been implemented in clinical practice as a promising alternative to medical management for preventing thromboembolic events in patients with atrial fibrillation (AF).

• #1 Stroke Prevention in Atrial Fibrillation | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/stroke-atrial-fibrillation/research

  Evidence evaluating interventions for stroke prevention was limited by the small number of studies for specific comparisons and lack of direct comparisons of novel anticoagulants, although many included studies were good-quality randomized controlled trials involving more than 5,000 patients. […] We found that a factor IIa inhibitor (dabigatran 150 mg) was superior to warfarin in reducing the incidence of stroke (including hemorrhagic) or systemic embolism (relative risk [RR] 0.66; 95% CI 0.53 to 0.82), with no significant difference in the occurrence of major bleeding (RR 0.93; 95% CI 0.81 to 1.07) (high strength of evidence for both outcomes). […] The Xa inhibitor rivaroxaban was noninferior to warfarin in preventing stroke or systemic embolism (moderate strength of evidence), with similar rates of major bleeding and death (high strength of evidence).

• #1 Thromboprophylaxis for atrial fibrillation

  https://www.escardio.org/Journals/E-Journal-of-Cardiology-Practice/Volume-5/Thromboprophylaxis-for-Atrial-Fibrillation-Title-Thromboprophylaxis-for-Atria

  Anticoagulation therapy is superior to antiplatelet therapy in preventing strokes in AF. […] The provision of thromboprophylaxis for AF has many clinical trials to inform an appropriate management strategy. Generally, anticoagulation therapy reduces strokes by two-thirds compared to control, whilst aspirin reduces stroke by one-fifth. […] The superiority of anticoagulation therapy (with a 40% risk reduction) over aspirin as thromboprophylaxis in patients with nonvalvular AF is clear. […] Aspirin has been used as an alternative to prescribing warfarin, despite the evidence that aspirin is poorly effective for stroke reduction in high risk AF patients. […] The overall benefit for aspirin in stroke reduction is 22% with fairly wide confidence intervals, almost including unity, indicating no benefit.

• #1 Atrial fibrillation secondary prevention – wikidoc

  https://www.wikidoc.org/index.php/Atrial_fibrillation_secondary_prevention

  It is critical to control any bleeding risk in patients who are receiving treatment for atrial fibrillation. Based on NICE guideline the following interventions should be done in order to prevent bleeding: Control uncontrolled hypertension, Check INR properly in patients who are receiving vitamin K antagonists, Control medication history of your patient (check for medications that can increase the risk of bleeding, such as selective serotonin reuptake inhibitor (SSRIs), Non-steroidal anti-inflammatory drugs (NSAIDs) and antiplatelet drugs), Ask patients to avoid excess alcohol drinking, Treat anemia.

• #1 Atrial Fibrillation and Stroke Prevention

  https://phoenixchildrens.staywellsolutionsonline.com/RelatedItems/134,508

  Atrial fibrillation (AFib) increases the risk for stroke. So stroke prevention is an important part of treatment for atrial fibrillation. […] For this reason, providers advise that many people who have AFib take a blood thinner to prevent clots from forming and reduce their risk of stroke. […] Your health care provider may advise using a blood-thinner medicine, depending on your risk factors for stroke. […] Your health care provider will work closely with you to find the right medicines for you to help prevent stroke. […] Each person’s risk for stroke is evaluated on an individual basis. If you have risk factors for stroke, you will likely need blood-thinning medicines. […] A device may be used to close off the left atrial appendage in some cases. This can prevent stroke without having to use lifelong blood thinners.

• #1 Atrial Fibrillation & Stroke Prevention Management – Cardiovascular Institute Of San Diego

  https://www.cvisd.com/services/atrial-fibrillation-stroke-prevention-management/

  Atrial Fibrillation Stroke Prevention […] Identifying atrial fibrillation is so important because patients with this irregular heart rhythm are more than five times more likely to have a stroke because blood clots form easily when the heart isnt in sync. […] Today, a number of treatments including blood thinner medication or Left Atrial Appendage Closure (LAAC) implants like WATCHMANTM are available to protect you from strokes related to your AFib. […] Currently, blood thinner medication is the first-choice option for stroke risk reduction. […] WATCHMAN is a onetime, minimally invasive procedure that reduces stroke risk without the worries that come with a lifetime of blood thinners.

• #1 Strategies for Stroke Prevention in Vulnerable Patients with Atrial Fibrillationlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na51915/2020/07/01/strategies-stroke-prevention-vulnerable-patients-with

  A randomized trial demonstrated noninferiority of left atrial appendage closure and direct oral anticoagulation. […] For patients with nonvalvular atrial fibrillation (AF), left atrial appendage closure (LAAC) with a percutaneous device is noninferior to oral anticoagulation with a vitamin K antagonist (VKA) and reduces risk for hemorrhagic stroke. […] The primary composite endpoint — stroke or transient ischemic attack, systemic embolism, clinically significant bleeding, cardiovascular death, or significant periprocedural or device-related complications — occurred in 11.0% and 13.4% per 100 patient-years in patients receiving LAAC and DOAC, respectively, a nonsignificant difference with a noninferiority margin of 5% (hazard ratio, 0.84; 95% CI, 0.53–1.31). […] This study should prompt reconsideration of how we incorporate LAAC into our stroke prevention strategies, balancing patients’ individual preferences with their risks for thromboembolism, bleeding, and procedural complications.

• #1 7. Anticoagulant Therapy for Atrial Fibrillation | Canadian Stroke Best Practices

  https://www.strokebestpractices.ca/recommendations/secondary-prevention-of-stroke/anticoagulation-for-individuals-with-stroke-and-atrials-fibrillation

  For patients with atrial fibrillation who experience ischemic stroke or transient ischemic attack in spite of anticoagulant therapy, we recommend the following: (1) identify and address medication nonadherence; (2) ensure correct DOAC dosing or warfarin INR control; (3) avoid DOACs drug-drug interactions; (4) investigate for and treat other potential stroke etiologies, and (5) promote general vascular risk factor modification [Evidence Level C]. […] Atrial fibrillation (AF) is a significant risk factor for stroke, and a strong example of the heart brain connection. One in six patients admitted to hospital in Canada with ischemic stroke have atrial fibrillation, and this proportion increases with age. […] In the general population, people with atrial fibrillation who are not treated with anticoagulant therapy are at a 3 to 5 times increased risk of stroke. Most strokes in individuals with atrial fibrillation are potentially preventable with anticoagulant therapy. […] Detection of atrial fibrillation is a critical step in stroke workups. Searching for atrial fibrillation post-stroke with prolonged ECG monitoring has been found to increase detection rates significantly, thereby enabling treatment aimed at preventing recurrent stroke.

• #1 Recommendation: Atrial Fibrillation: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/atrial-fibrillation-screening

  Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter. […] The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined. […] The primary rationale for screening for AF in asymptomatic persons is to initiate oral anticoagulant medications in persons at sufficiently high risk to prevent a thromboembolic event. […] Patients with clinical AF not receiving anticoagulant therapy have an increased risk of stroke, and strokes associated with AF tend to be more severe than strokes attributed to other causes.

• #1 Increased Prevention and Treatment Needed for Common Cardiovascular Condition – AFib

  https://www.northwesthealth.com/news-room/increased-prevention-and-treatment-needed-for-comm-21222

  The prevalence of one of the most common cardiovascular conditions in the U.S. is significantly higher than previously estimated, underscoring the need for better prevention and treatment strategies. […] The U.S. Preventive Services Task Force recommends adults without symptoms of atrial fibrillation or other risk factors should be screened at age 50. […] Atrial fibrillation is highly treatable with lifestyle modifications, medication, and in some cases surgical procedures, said Ahmad Elesber, M.D., interventional cardiologist at Northwest Cardiology Springdale. […] Left untreated, AFib can have devastating consequences for patients and their families, so it is important to get screened if you are in a high-risk group or have symptoms, Dr. Elesber added. […] Patients who are at high risk for AFib should maintain regular wellness checks with a primary care physician and talk with their doctor about their concerns and further screening.

• #1 Recommendation: Atrial Fibrillation: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/atrial-fibrillation-screening

  However, the current evidence is insufficient for the USPSTF to recommend for or against screening for AF. Additionally, the stroke risk associated with subclinical AF, particularly subclinical AF of shorter duration (less than several to 24 hours) or lower burden (amount or percentage of time spent in AF), as might be detected by some screening approaches, is uncertain, and the duration of subclinical AF that might warrant anticoagulant therapy is unclear. […] The performance of ECG or use of portable or wearable rhythm monitoring devices is not associated with significant harm, although abnormal test results may cause anxiety. Misinterpretation of a screening test result may lead to misdiagnosis and unnecessary treatment. Treatment of AF can include anticoagulant therapy for stroke prevention, which is associated with a risk of bleeding. […] More studies are needed that address the following: Randomized trials enrolling asymptomatic persons that directly compare screening with usual care and that assess both health outcomes and harms are needed to understand the balance of benefits and harms of screening for AF.

• #1 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Patients With Atrial Fibrillation – HRS

  https://www.hrsonline.org/guidance/clinical-resources/2023-accahaaccphrs-guideline-diagnosis-and-management-patients-atrial-fibrillation

  The American College of Cardiology (ACC) and American Heart Association (AHA) released updated recommendations for preventing and managing atrial fibrillation. […] This comprehensive document updates the recommendations from the 2014 and 2019 guidelines on atrial fibrillation and includes new recommendations on atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention.

• #1

  https://www.healio.com/news/cardiology/20231130/new-atrial-fibrillation-guideline-highlights-early-rhythm-control-prevention-strategies

  An updated guideline on the prevention and management of atrial fibrillation includes a new staging system to emphasize disease progression, along with updated recommendations for catheter ablation and left atrial appendage occlusion. […] Lifestyle and risk factor modification are now deemed to be a key component to prevent onset of AF, progression of AF and poor outcomes from AF. […] The updated guideline emphasizes risk factor management throughout the disease continuum, including recommendations for weight loss for people with overweight or obesity, BP control for people with hypertension, moderation of alcohol intake and smoking cessation. […] The guideline also includes specific recommendations on the quality and quantity of physical activity for people at risk for and living with AF.

• #2 Atrial Fibrillation: Risk factors, Treatment, and Prevention | Kettering Health

  https://ketteringhealth.org/atrial-fibrillation-risk-factors-treatment-and-prevention/

  According to the Centers for Disease Control (CDC), somewhere between 2.7 and 6.1 million Americans suffer from atrial fibrillation, commonly called “AFib.” […] Knowing the symptoms of AFib, its risk factors, preventative steps, and treatment can help improve the quality of life for those who suffer from this kind of heart problem. […] As always, prevention is the best medicine. Even those already experiencing AFib can do things to minimize its recurrence. The most important thing you can do to prevent the condition is to follow typical cardiovascular health recommendations, such as maintaining a healthy, low-sodium diet; regular exercise; keeping weight under control and treating any existing conditions such as high blood pressure. […] People who suffer from sleep apnea should make sure to have it properly treated, and if AFib is already a concern for you, avoid triggers like excessive caffeine or stress.

• #2 Stroke Prevention in Atrial Fibrillation – Heart Rhythm Clinic of Michigan

  https://hrcmichigan.com/education/stroke-prevention-in-atrial-fibrillation/

  Many patients with atrial fibrillation are at risk for stroke and need anticoagulation therapy. On Average, people with AFib have a stroke risk five to seven times higher than those who do not have AFib. Because of the adverse effects a stroke can have on quality and duration of life, stroke prevention is a primary treatment goal in AFib. […] There are a variety of treatments to prevent stroke, but a group of medications called anticoagulants are the most common first-line treatment. Anticoagulants are highly effective at lowering the likelihood of stroke related to AFib. When taken as prescribed, all anticoagulants significantly reduce the risk of stroke due to blood clots. Each type of anticoagulant has its own benefits and risks. […] However some patients have a high risk of bleeding with long term use of this type of therapy. New medications and procedures are available to help manage the risks of both stroke and bleeding in these patients with atrial fibrillation.

• #2 Atrial Fibrillation Guideline Updated

  https://www.uspharmacist.com/article/atrial-fibrillation-guideline-updated

  The updated guideline recognizes lifestyle and risk factor modification as a pillar of AFib management to prevent the onset, progression, and adverse outcomes and also emphasizes risk factor management throughout the course of AFib, including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities, as applicable. […] In general, the goals of managing patients with AFib using shared decision-making and a patient-centered approach are to diminish the symptom burden, maintain sinus rhythm, and diminish or avert the risk of complications such as thromboembolic events/stroke. […] According to the USPSTF, to prevent or reduce the risk of a thrombotic event, the use of anticoagulants is employed in patients at elevated risk.

• #2 10 ways to stop and prevent and AFib episode

  https://www.medicalnewstoday.com/articles/320285

  Methods to help stop an atrial fibrillation (AFib) episode include stress management techniques, such as deep breathing and muscle relaxation. Treating the underlying cause, dietary changes, and exercising can also help prevent episodes. […] The regular practice of stress management techniques, such as focused deep breathing, muscle relaxation, and yoga could reduce the risk of an AFib episode. […] Recent guidelines suggest that aerobic exercise may be particularly beneficial in reducing AFib. […] This research suggests that avoiding or limiting alcohol may be one way to stop an AFib episode. […] If a person smokes, taking steps to reduce or stop smoking may help with managing AFib. […] Following a heart healthy diet may be particularly beneficial for people with AFib. […] Current guidelines recommend weight loss for people with AFib and overweight or obesity. This can result in a reduction in arrhythmia symptoms, how frequently they occur, and the related burden.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20231130/New-guideline-emphasizes-prevention-early-rhythm-control-for-atrial-fibrillation.aspx

  The updated guideline calls for a stronger, more prescriptive focus on healthy lifestyle habits to prevent or lessen the burden of AFib, as well as early and more aggressive rhythm control in general, including upgraded recommendations for catheter ablation as first line therapy to prevent disease progression. […] There is clearer focus on risk factor modification – for example, weight loss and obesity prevention, physical activity, smoking cessation, limiting alcohol, and controlling blood pressure and other comorbidities – to help prevent AFib or ameliorate any recurrences or worsening of the disease. […] The new guideline reinforces the urgent need to approach AFib as a complex cardiovascular condition that requires disease prevention, risk factor modification, as well as optimizing therapies and patients’ access to care and ongoing, long-term management.

• #2 Lifestyle Changes for Atrial Fibrillation & Atrial Flutter | NYU Langone Health

  https://nyulangone.org/conditions/atrial-fibrillation-atrial-flutter/treatments/lifestyle-changes-for-atrial-fibrillation-atrial-flutter

  People who have atrial fibrillation (AFib) and atrial flutter are at increased risk for conditions that affect the heart, such as high blood pressure, coronary artery disease, and heart attack. By following a heart-healthy lifestyle, you can limit experiences that trigger AFib or atrial flutter, as well as reduce your risk of heart disease. […] Heart specialists at NYU Langones Heart Rhythm Center recommend the following lifestyle changes for atrial flutter and atrial fibrillation management. […] A healthy diet and exercise play a major role in preventing heart disease and reducing symptoms related to AFib and atrial flutter. […] Limiting caffeine and alcohol can reduce symptoms of arrhythmia. […] If you smoke or use tobacco products, its recommended that you stop. […] To ease symptoms of sleep apnea, sleep experts may recommend reducing or eliminating alcohol and sedative use, changing your sleep position, or using a mouth guard or continuous positive airway pressure (CPAP) device that keeps the airway open while you sleep. […] Studies have shown that too much stress can raise your blood pressure and trigger AFib or atrial flutter. […] Exercise can help you lose weight and reduce high blood pressure. Taking a brisk 30-minute walk every day can improve your heart health and reduce the risk of triggering an arrhythmia.

• #2 Diagnosis and Treatment of Atrial Fibrillation | American Heart Association

  https://www.heart.org/en/health-topics/atrial-fibrillation/treatment-and-prevention-of-atrial-fibrillation

  Making lifestyle changes can help lower the risk of stroke and blood clots. […] Not all strokes or clots can be prevented, but there are ways to reduce the risks. […] Preventing blood clots. […] Managing stroke risk factors. […] Your health care professional may suggest lifestyle changes, including: Getting regular physical activity, Eating a heart-healthy diet low in: Salt (sodium), Saturated fats, Trans fats, Cholesterol, Managing high blood pressure, Limiting alcohol and caffeine, Not smoking, Controlling cholesterol, Reaching and maintaining a healthy weight. […] Our guide can help you learn more about AFib, ways to manage it and how to reduce your risk for stroke.

• #2 Patient education – Atrial Fibrillation or Flutter – UF Health

  https://ufhealth.org/conditions-and-treatments/atrial-fibrillation-or-flutter/patient-education

  Talk to your provider about steps to treat conditions that cause atrial fibrillation and flutter. Avoid binge drinking. […] People with AFib will most often need to take blood thinner medicines. These medicines are used to reduce the risk of developing a blood clot that travels in the body (and that can cause a stroke, for example). The irregular heart rhythm that occurs with AFib makes blood clots more likely to form. […] Another stroke prevention option for people who cannot safely take these medicines is the Watchman Device, which has recently been approved by the FDA. This is a small basket-shaped implant that is placed inside the heart to block off the area of the heart where most of the clots form. This limits clots from forming.

• #2 Atrial fibrillation – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/atrial-fibrillation/symptoms-causes/syc-20350624

  Healthy lifestyle choices can reduce the risk of heart disease and may prevent atrial fibrillation (AFib). Here are some basic heart-healthy tips: […] Control high blood pressure, high cholesterol and diabetes. […] Don’t smoke or use tobacco. […] Eat a diet that’s low in salt and saturated fat. […] Exercise at least 30 minutes a day on most days of the week unless your health care team says not to. […] Get good sleep. Adults should aim for 7 to 9 hours daily. […] Maintain a healthy weight. […] Reduce and manage stress.

• #2 Risk Factor Management in Atrial Fibrillation | AER Journal

  https://www.aerjournal.com/articles/risk-factor-management-atrial-fibrillation?language_content_entity=en

  AF treatment has largely focused on the prevention of stroke and HF as well as symptom control, as reflected in previous European and current American guidelines for the management of AF. […] The present review focuses on the detection and treatment of associated diseases and risk factors, i.e. the targeting of underlying conditions. […] This association was even higher if prolonged noninvasive or invasive monitoring was performed following a stroke. […] These findings call for earlier diagnosis and comprehensive treatment of AF to reduce stroke risk and improve outcomes. […] In recent years, a number of risk factors and conditions have been identified that are associated with the development and progression of AF. […] Timely treatment of risk factors and underlying conditions could lead to improvement of both conditions and reduce adverse outcomes. […] Optimal and timely management targeting these conditions is feasible, reduces AF and improves quality of life.

• #2 Pharmacologic prophylaxis for atrial fibrillation following cardiac surgery: a systematic review

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3006380/

  In conclusion, b-blockers should routinely be used as first choice for the prophylaxis of AF in all patients undergoing cardiac surgery, unless otherwise contraindicated (Grade A recommendation based on level 1a studies). Sotalol may be more effective than standard b-blockers for the prevention of AF without causing an excess of side effects (Grade A recommendation based on level 1b studies). Amiodarone should be used for prophylaxis of AF in all patients undergoing cardiac surgery in which b-blocker therapy is not possible (Grade A recommendation based on level 1a and1b studies). In high-risk patients receiving b-blocker therapy for prophylaxis of AF, amiodarone may also be used as additional prophylaxis with an acceptably low incidence of complications.

• #2 Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials | EuroIntervention

  https://eurointervention.pcronline.com/article/posterior-pericardiotomy-for-the-prevention-of-atrial-fibrillation-after-cardiac-surgery-a-systematic-review-and-meta-analysis-of-25-randomised-controlled-trials

  The current meta-analysis revealed that PP effectively decreases postoperative pericardiac tamponade compared to the control. […] Our results suggest that PP is a viable option for chest drainage that can lessen the likelihood of cardiac tamponade without raising the probability of pulmonary complications. […] In conclusion, this systematic review and meta-analysis found that PP effectively reduced the risk of new-onset POAF, pericardial effusion, pericardial tamponade, bleeding problems, and length of hospital stay following CABG. […] Given these results, it seems reasonable to conclude that PP is a straightforward surgical procedure with minimal risk that should be considered in future practice.

• #2 Recommendation: Atrial Fibrillation: Screening | United States Preventive Services Taskforce

  https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/atrial-fibrillation-screening

  Atrial fibrillation is a major risk factor for ischemic stroke and is associated with a substantial increase in the risk of stroke. Approximately 20% of patients who have a stroke associated with AF are first diagnosed with AF at the time of the stroke or shortly thereafter. […] The USPSTF concludes that evidence is lacking, and the balance of benefits and harms of screening for AF in asymptomatic adults cannot be determined. […] The primary rationale for screening for AF in asymptomatic persons is to initiate oral anticoagulant medications in persons at sufficiently high risk to prevent a thromboembolic event. […] Patients with clinical AF not receiving anticoagulant therapy have an increased risk of stroke, and strokes associated with AF tend to be more severe than strokes attributed to other causes.

• #2 Stroke Prevention in Atrial Fibrillation | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/stroke-atrial-fibrillation/research

  The Xa inhibitor apixaban was superior to warfarin in reducing the incidence of stroke or systemic embolism (hazard ratio [HR] 0.79; 95% CI 0.66 to 0.95; high strength of evidence); major bleeding (HR 0.69; 95% CI 0.60 to 0.80; high strength of evidence); and all-cause mortality (HR 0.89; 95% CI 0.80 to 0.998; moderate strength of evidence). […] Apixaban was also superior to aspirin in reducing the incidence of stroke or systemic embolism (HR 0.45; 95% CI 0.32 to 0.62), with similar hemorrhagic events, including major bleeding (HR 1.13; 95% CI 0.74 to 1.75), in patients who are not suitable for oral anticoagulation (high strength of evidence for both outcomes). […] Overall, we found that CHADS2 and CHA2DS2-VASc scores have the best discrimination ability for stroke events in patients with AF among the risk scores we reviewed, whereas HAS-BLED provides the best discrimination of bleeding risk.

• #2 Atrial Fibrillation and Stroke Prevention

  https://phoenixchildrens.staywellsolutionsonline.com/RelatedItems/134,508

  Your health care team will work hard to make sure you are getting the right amount of medicine for you by balancing these risks. They will only prescribe medicines if the benefits of stroke prevention are greater than the risks for bleeding. […] Your health care provider may give you other instructions about how to lower your risk for stroke.

• #2 Azthena logo with the word Azthena

  https://www.news-medical.net/news/20231130/New-guideline-emphasizes-prevention-early-rhythm-control-for-atrial-fibrillation.aspx

  Catheter ablation was given the highest Class 1 treatment recommendation for appropriately selected patients, including those with heart failure with reduced ejection fraction. […] „The new guideline gives clinicians flexibility to use other predictive tools, and we hope this will also enhance communication and shared decision-making with patients,” Joglar said, adding that there is enhanced focus on the use of left atrial appendage closure devices for stroke prevention.

• #3 Atrial Fibrillation: Symptoms, Causes, and Treatments

  https://patient.info/heart-health/atrial-fibrillation-leaflet

  Atrial fibrillation can’t always be prevented, but there are things that you can to which reduce the risk of it happening. These include: […] Limit the amount of alcohol you drink, and avoid binge drinking. Alcohol is strongly linked to atrial fibrillation. Heavy alcohol use (especially binge drinking) is commonly-recognised amongst doctors as a trigger for episodes of AF, but more recent research has shown that drinking even a modest amount of alcohol regularly increases the risk of AF. […] Avoid, or stop, smoking. Smoking tobacco increases the risk of developing AF. […] Avoid using drugs such as cocaine, cannabis, methamphetamines, and opiates. […] Stay physically active and exercise regularly. Aim to get at least 150 minutes of moderate-intensity exercise each week (which can be broken down into smaller chunks). Exercise has many health benefits. It can help to prevent atrial fibrillation and is also good for people who already have atrial fibrillation.

• #3 Stroke Prevention in Atrial Fibrillation | Effective Health Care (EHC) Program

  https://effectivehealthcare.ahrq.gov/products/stroke-atrial-fibrillation/research

  Newer anticoagulants show early promise of reducing stroke and bleeding events when compared with warfarin, and apixaban shows safety and efficacy in patients who are not candidates for warfarin. […] However, further studies are required for key clinical scenarios involving anticoagulation use and procedures, switching or bridging therapies, and when to start anticoagulation after a hemorrhagic event.

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