Physician Update: AHA Special Edition
Read more articles from our most relevant research presented at the 2024 AHA Scientific Sessions.
Clinical Heart and Vascular Center
Applications and Implications of the 2023 ACC/AHA/ACCP/HRS Guideline for Atrial Fibrillation Care and Stroke Prevention
By Jose Joglar, M.D.
Professor of Internal Medicine
Vice Chair for Internal Medicine Clinical Affairs, Parkland Health
It was my pleasure to participate in the cardiovascular seminar titled “AFib and the Heart Brain Axis: From Patient to Population, From Innovation to Implementation” at #AHA24. Within the context of the seminar’s focus on diverse medical and surgical strategies for stroke prevention and management in patients with atrial fibrillation, as Chair of the writing committee for the 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation, my role in the seminar was to provide an update on the latest practice recommendations for stroke prevention in this population.
Among the most important changes in the 2023 guideline compared to prior iterations was the indication for anticoagulation. Specifically, we now recommend anticoagulation based on magnitude of risk rather than exclusively on the CHA2DS2-VASc score. This approach allows for flexibility in using other clinical risk scores when deemed clinically necessary, thereby enhancing shared decision-making and allowing for consideration of other risk factors not incorporated in CHA2DS2-VASc score. This approach also allows for better guidance when the risk of stroke is dissociated from what would be predicted by CHA2DS2-VASc, such as in device-detected atrial fibrillation.
“[W]e now recommend anticoagulation based on magnitude of risk rather than exclusively on the CHA2DS2-VASc score.”
A second important difference in this edition of the guideline is that, based on new evidence, the threshold of anticoagulation changes in women. A recent study showed that although women with atrial fibrillation were at higher risk of stroke than men, that risk does not become evident until other risk factors are present. Thus, for example, a class 1 recommendation is given for initiating anticoagulation in patients with a risk of ≥ 2% per year of stroke, which would be equivalent to a CHA2DS2-VASc score of ≥ 2 in men and ≥ 3 in women, compared to previously when the class 1 recommendation was given to those with a CHA2DS2-VASc of 2 or greater regardless of sex.
