Stratifying Stroke Risk in Atrial Fibrillation: Beyond Clinical Risk Scores

Shadi Yaghi, MD; Hooman Kamel, MD


Stroke. 2017;48(10):2665-2670. 

In This Article

Abstract and Introduction


Atrial fibrillation (AF) is the most common atrial arrhythmia, affecting ≍1% of the US population.[1] This estimate may understate its true burden, given that a high proportion of patients have subclinical AF. The prevalence of AF increases with age,[1,2] and given an aging population, the projected prevalence of AF in the United States is at least 5.6 million by the year 2050.[2]
AF is associated with increased risk of stroke or systemic embolism[3] and death.[4] The heightened thromboembolic risk seen in AF is substantially reduced by anticoagulation.[5] On the contrary, long-term anticoagulation can also lead to hemorrhagic complications. The recommended approach to making decisions about anticoagulant therapy in AF is to balance the expected risks of stroke versus bleeding. In this article, we review the widely used clinical methods for predicting stroke risk in AF and augment this discussion with an overview of more recent risk predictors beyond conventional clinical scores.