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Understanding Risk

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

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Understanding Risk

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

  2. 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

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

  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

  6. ESC 2010 AF Guidelines

  7. Since 2010, further validation of theCHA2DS2-VASc score Lip GY. J ThrombHaemost. 2011;9 Suppl 1:344–351. PotparaTS, et al. Circ ArrhythmElectrophysiol. 2012;5:319–326. Olesen JB, et al. ThrombHaemost. 2012;107:1172–1179. Van Staa TP, et al. J ThrombHaemost.2011;9:39–48. Abu-Assi E, et al. IntJ Cardiol. 2013;166:205–209. Camm AJ, et al. EurHeart J. 2012;33:2719–2747. Courtesy Prof. R. de Caterina

  8. ESC 2012 AF Guidelines update Adapted from Olesen JB, et al. Br Med J. 2011;342:doi: 10.1136/bmj.d124.

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

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

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

  12. 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

  13. 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

  14. Rate of stroke/systemic embolism according to CHA2DS2-VAScscore of 0 versus 1-9: 0.2% 1.1%

  15. 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”

  16. Thank you for your attention

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