Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone .
In patients at high risk of stroke , anticoagulation is cost effective , but not for those with a low risk of stroke .
The risk of stroke in atrial fibrillation ( AF ) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis , with the aim of appropriate use of antithrombotic therapy .
To achieve this , stroke risk factors in AF population s need to be identified and stroke risk stratification models have been devised on the basis of these risk factors .
In this article , we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical , demographic and echocardiographic patient characteristics in AF population s. Secondly , we performed a systematic review of published stroke risk stratification models , in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk .
Asymptomatic atrial fibrillation: demographic features and prognostic information from the Atrial Fibrillation Follow-up Investigation of Rhythm Management (AFFIRM) study.
BACKGROUND Atrial fibrillation  ( AF ) may occur without symptoms . Little is known about demographic features and prognostic information in patients with asymptomatic AF . METHODS In the AFFIRM study , 4060 patients were r and omized to either rhythm or rate control . At baseline , patients were identified as asymptomatic if they answered " no " to a 15-item question naire related to cardiac symptoms during AF in the 6 months before study entry . RESULTS There were 481 ( 12 % ) asymptomatic patients at baseline . Compared with symptomatic patients , asymptomatic patients were more often men and had a lower incidence of coronary artery disease and congestive heart failure , but had more cerebrovascular events . Asymptomatic patients had a longer duration of AF , a lower maximum heart rate , and better left ventricular function . They received fewer cardiac medications and fewer therapies to maintain sinus rhythm . At 5 years , there was a trend for better survival in asymptomatic patients ( 81 % vs 77 % , P = .058 ) , and they were more likely to be free from disabling stroke or anoxic encephalopathy , major bleeding , and cardiac arrest ( 79 % vs 67 % , P = .024 ) . However , mortality and major events were similar after correction for baseline differences . CONCLUSIONS Patients with asymptomatic AF have less serious heart disease but more cerebrovascular disease . Asymptomatic patients receive different therapies than symptomatic patients . However , the absence of symptoms and the differences in treatment does not confer a more favorable prognosis when differences in baseline clinical parameters are considered . Anticoagulation should be considered in these patients
Few models had addressed the cumulative nature of risk factors where a combination of risk factors would confer a greater risk than either factor alone .
In patients at high risk of stroke , anticoagulation is cost effective , but not for those with a low risk of stroke .
The risk of stroke in atrial fibrillation ( AF ) needs to be assessed in each patient to determine the clinical and cost-effectiveness of thromboprophylaxis , with the aim of appropriate use of antithrombotic therapy .
To achieve this , stroke risk factors in AF population s need to be identified and stroke risk stratification models have been devised on the basis of these risk factors .
In this article , we firstly provide a systematic review of studies examining the attributable stroke risk of various clinical , demographic and echocardiographic patient characteristics in AF population s. Secondly , we performed a systematic review of published stroke risk stratification models , in terms of the results of the review of stroke risk factors and their ability to accurately discriminate between different levels of stroke risk .