Presentation on theme: "Understanding Risk Professor Dan Atar, MD, FESC Dept. of Cardiology"— Presentation transcript:
1 Understanding Risk Professor Dan Atar, MD, FESC Dept. of Cardiology Oslo University HospitalOslo, NorwayVice-President of the ESC ( )
2 Professor Dan Atar: Disclosures Co-author of ESC Guidelines on Atrial FibrillationSteering Committee member, National Coordinator for Norway, and Co-author of ACTIVE, ARISTOTLE, AVERROES, GARFIELD-AF, XANTUS, RE-ALIGNFees, 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
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 innon-valvular AF - generalRecommendationsClassLevelThe CHA2DS2-VASc score is recommended as a means of assessing stroke risk in non-valvular AF.IACamm AJ, et al. Eur Heart J. 2012;33:2719–2747.Courtesy Prof. R. de Caterina
8 ESC 2012 AF Guidelines update CHA2DS2-VASc scorePatients (n=73538)Stroke and thromboembolism event rate at 1 year follow-up (%)63690.78182032.012127713.713173715.924138879.275894215.266424419.747142021.50828522.3894623.64Adapted 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-VAScPercentagePercentage
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 RegistryJean-Pierre Bassand et al., for the GARFIELD-AF InvestigatorsTuesday, 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 of0 versus 1-9:0.2% 1.1%
16 ConclusionsIn patients with A-Fib, the estimation of individual risk of stroke is key before any therapeutic decision is madeCHA2DS2-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 therapyAll other patients ought to receive anticoagulation for the indication of “SPAF”