This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression
Patients with atrial fibrillation ( AF ) are commonly managed with rhythm control strategy , but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF , and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation .
Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF .
The more common factors have been used to formulate risk stratification scores , to help predict the outcomes of rhythm control treatments  or AF progression .
A novel risk prediction score in atrial fibrillation for a net clinical outcome from the ENGAGE AF-TIMI 48 randomized clinical trial
Aims The choice between initiating a non-vitamin K antagonist oral anticoagulant ( NOAC ) and a vitamin K antagonist ( VKA ) in patients with atrial fibrillation ( AF ) may be challenging . To assist in this decision , we developed a risk score to identify patients for whom a therapeutic benefit of NOACs over VKA is predicted . Methods and results ENGAGE AF-TIMI 48 was a r and omized clinical trial of edoxaban vs. warfarin in 21 105 patients with AF . Cox proportional hazard models identified factors associated with a serious net clinical outcome ( NCO ) of disabling stroke , life-threatening bleeding , and all-cause mortality in VKA naïve patients from the warfarin arm . These were used to develop an integer risk score . Performance was assessed by C-indices and validation by bootstrapping . Kaplan-Meier analyses were stratified by three score categories and treatment arm . Over a median of 2.7 years , 457  NCO events occurred in 2898 patients with a total person-time of 7549.5 years ( 6.05%/year ) . The risk prediction model ( C = 0.693 ) for the NCO was translated into a 17-point integer score , with annualized event rates for the low , intermediate , and high-risk categories in the warfarin arm of 3.5 % , 9.9 % , and 20.8 % , respectively . Therapeutic benefit of higher- and lower-dose edoxaban over warfarin was demonstrated in the high- and intermediate-risk , with equal benefit in the low-risk categories ( P-interaction 0.008 and 0.014 , respectively ) . Conclusion In VKA naive patients with AF , the TIMI-AF score can assist in the prediction of a poor composite outcome and guide selection of anticoagulant therapy by identifying a differential clinical benefit with a NOAC or VKA
This review article provides an overview on the published clinical risk scores related to outcomes of rhythm control strategy or AF progression
Patients with atrial fibrillation ( AF ) are commonly managed with rhythm control strategy , but the natural history of this common arrhythmia leads itself to progression from paroxysmal to persistent or permanent AF , and recurrences are evident despite rhythm control treatments using cardioversion or catheter ablation .
Numerous clinical factors have been associated with outcomes of rhythm control or arrhythmia progression in patients with AF .
The more common factors have been used to formulate risk stratification scores , to help predict the outcomes of rhythm control treatments  or AF progression .