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REVIEW

Digital tools and scores for estimating the risk of stroke and bleeding in atrial fibrillation

Kyra Dingle1† ,  Jeffrey E. Jones1† ,  Dhruvil Ashishkumar Patel2 ,  Camila Trejo-Paredes3 ,  Lynda E. Rosenfeld3 ,  Jiun-Ruey Hu3,4*
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1 School of Medicine, University of California Irvine, Irvine, California, United States of America
2 Department of Internal Medicine, University of Chicago Medical Center, Chicago, Illinois, United States of America
3 Section of Cardiovascular Medicine, Department of Internal Medicine, Yale School of Medicine, New Haven, Connecticut, United States of America
4 Department of Cardiology, Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, United States of America
Brain & Heart 2024, 2(3), 3068 https://doi.org/10.36922/bh.3068
Submitted: 1 March 2024 | Accepted: 29 May 2024 | Published: 7 August 2024
© 2024 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution 4.0 International License ( https://creativecommons.org/licenses/by/4.0/ )
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Abstract

Atrial fibrillation (AF) is a significant risk factor for cardioembolic stroke; however, therapeutic anticoagulation for stroke prevention in patients with AF also increases the risk of bleeding. Over the past two decades, extensive efforts have focused on refining patient stratification into risk categories to guide the selection of anticoagulant therapy. Various scores have been developed to estimate stroke risk in patients with AF, including CHADS2, Framingham, CHA2DS2-VASc, ATRIA, ABC, GARFIELD-AF, and IMRS-VASc, with CHA2DS2-VASc being the most widely utilized. Similarly, scores such as HEMORR2HAGES, HAS-BLED, ORBIT, ATRIA, GARFIELD-AF, and the newly introduced DOAC are utilized to estimate bleeding risk, with HAS-BLED being predominant. In recent years, numerous digital tools have been developed to assist physicians and patients in visualizing the risk of stroke and bleeding in an interactive manner, to strengthen the use of evidence-based medicine, and to facilitate shared decisionmaking. These tools include the American College of Cardiology’s AnticoagEvaluator app, Mayo Clinic Anticoagulation Choice Decision Aid, Stroke Prevention in Atrial Fibrillation Risk Tool (SPARCtool), GARFIELD-AF Risk Calculator, and CardioSmart Atrial Fibrillation and Bleeding Risk Calculator. This review explores the evolution of these risk scores, evaluating their merits and drawbacks while highlighting common variables across multiple risk scores. In addition, it describes the landscape of novel digital tools designed for decision-making, offering insights from the perspective of physician users.

Keywords
Atrial fibrillation
Anticoagulation
Bleeding
Stroke
Digital tools
Risk score
Funding
None.
Conflict of interest
The authors declare that they have no competing interests.
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Brain & Heart, Electronic ISSN: 2972-4139 Published by AccScience Publishing
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