Understanding Risk Professor Dan Atar, MD, FESC Dept. of Cardiology

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Presentation transcript:

Understanding Risk Professor Dan Atar, MD, FESC Dept. of Cardiology Oslo University Hospital Oslo, Norway Vice-President of the ESC (2014-16)

Professor Dan Atar: Disclosures Co-author of 2010-2012 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

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

A logical sequence to AF management ESC 2010 AF Guidelines

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

ESC 2010 AF Guidelines

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

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: 10.1136/bmj.d124.

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

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

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

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

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

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

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”

Thank you for your attention 17