1. Understanding Risk Professor Dan Atar, MD, FESC Dept. of Cardiology
Oslo University Hospital
Oslo, Norway
Vice-President of the ESC ( )

2. Professor Dan Atar: Disclosures
Co-author of ESC Guidelines on Atrial Fibrillation
Steering Committee member, National Coordinator for Norway, and Co-author of ACTIVE, ARISTOTLE, AVERROES, GARFIELD-AF, XANTUS, RE-ALIGN
Fees, honoraria from Sanofi-Aventis, Merck (MSD), Boehringer- Ingelheim, Bayer, BMS/Pfizer, Daiichi-Sankyo, Nycomed-Takeda

3. European Heart Journal http://eurheartj.oxfordjournals.org/3

4. A logical sequence to AF management
ESC 2010 AF Guidelines

5. Adapted from Gage BF et al. JAMA. 2001; 285:2864-2870.
Courtesy Prof. R. de Caterina

6. ESC 2010 AF Guidelines

7. Since 2010, further validation of the CHA2DS2-VASc score
Lip GY. J Thromb Haemost. 2011;9 Suppl 1:344–351.
Potpara TS, et al. Circ Arrhythm Electrophysiol. 2012;5:319–326.
Olesen JB, et al. Thromb Haemost. 2012;107:1172–1179.
Van Staa TP, et al. J Thromb Haemost. 2011;9:39–48.
Abu-Assi E, et al. Int J Cardiol. 2013;166:205–209.
Recommendations for prevention of thromboembolism in
non-valvular AF - general
Recommendations
Class
Level
The CHA2DS2-VASc score is recommended as a means of assessing stroke risk in non-valvular AF. I A
Camm AJ, et al. Eur Heart J. 2012;33:2719–2747.
Courtesy Prof. R. de Caterina

8. ESC 2012 AF Guidelines update
CHA2DS2-VASc score
Patients (n=73538)
Stroke and thromboembolism event rate at 1 year follow-up (%)
6369
0.78 1
8203
2.01 2
12771
3.71 3
17371
5.92 4
13887
9.27 5
8942
15.26 6
4244
19.74 7
1420
21.50 8
285
22.38 9 46
23.64
Adapted from Olesen JB, et al. Br Med J. 2011;342:doi: /bmj.d124.

10. January CT, et al. Circulation. 2014;129:000-000.

11. January CT, et al. Circulation. 2014;129:000-000.

12. Stroke risk profile: CHADS2 / CHA2DS2-VASc
What do we know about risk in GARFIELD-AF?
Stroke risk profile: CHADS2 / CHA2DS2-VASc
Percentage
Percentage

13. Preliminary first year event rates according to number of risk factors
RF, risk factor (heart failure, LVEF <40%, hypertension, age ≥75, diabetes, previous stroke/TIA/SE, vascular disease, age 65–74 years, female gender)
Kakkar A, AHA-2012

14. Poster presentation at ESC
‘Truly low-risk’ patients with newly diagnosed non-valvular atrial fibrillation at risk of stroke: 1-year outcomes from the GARFIELD-AF Registry
Jean-Pierre Bassand et al., for the GARFIELD-AF Investigators
Tuesday, 2 September from 14:00–18:00 in the poster area of the Central Village

15. Rate of stroke/systemic embolism
according to CHA2DS2-VASc score of
0 versus 1-9:
0.2% 1.1%

16. Conclusions
In patients with A-Fib, the estimation of individual risk of stroke is key before any therapeutic decision is made
CHA2DS2-VASc is recommended as the primary instrument in estimating risk of stroke (ESC 2012 / AHA+ACC 2014)
The focus is to identify truly low-risk patients – these will not need anticoagulation therapy
All other patients ought to receive anticoagulation for the indication of “SPAF”

17. Thank you for your attention17