34
Management
6.1. Risk Stratification Schemes
COR LOE
Recommendations
1 B-NR 1. Patients with AF should be evaluated for their annual risk of
thromboembolic events using a validated clinical risk score,
such as CHA
2
DS
2
-VASc.
1 B-NR 2. Patients with AF should be evaluated for factors that
specifically indicate a higher risk of bleeding, such as previous
bleeding and use of drugs that increase bleeding risk, in order
to identify possible interventions to prevent bleeding on
anticoagulation.
2a C-LD 3. Patients with AF at intermediate annual risk of
thromboembolic events by risk scores (eg, equivalent to
CHA
2
DS
2
-VASc score of 1 in men or 2 in women), who
remain uncertain about the benefit of anticoagulation, can
benefit from consideration of factors that might modify their
risk of stroke to help inform the decision.*
3: No
benefit
B-NR 4. In patients who are deemed at high risk for stroke, bleeding
risk scores should not be used in isolation to determine
eligibility for oral anticoagulation but instead to identify and
modify bleeding risk factors and to inform medical decision-
making.
* Factors may include AF burden or other features in Table 3.
6. Prevention of Thromboembolism
5.2.10. Comprehensive Care
COR LOE
Recommendations
1 A 1. Patients with AF should receive comprehensive care
addressing guideline-directed LRFM, AF symptoms, risk of
stroke, and other associated medical conditions to reduce AF
burden, progression, or consequences.
2a B-R 2. In patients with AF, use of clinical care pathways, such as
nurse-led AF clinics, is reasonable to promote comprehensive,
team-based care and to enhance adherence to evidence-based
therapies for AF and associated conditions.
