CYTE and the Thrombosis Research Institute are pleased to see that the updated American College of
Cardiology/American Heart Association/American Association Joint Committee/Heart Rhythm
Society (ACC/AHA/ACCP/HRS) guidelines for the diagnosis and management of atrial fibrillation (AF)
highlight the potential advantages of newer risk scores compared with CHA 2 DS 2 -VASc, including the
GARFIELD-AF risk score that we introduced in 2017.

The improved ability to predict the risks to AF patients is significant because AF continues to be the
most common arrhythmia, and its prevalence has increased globally. It is estimated that the global
prevalence of AF is north of 50 million, as of 2020. The increasing global prevalence is mainly due to
an ageing population, rising prevalence of obesity, an increase in the detection and screening for AF,
and increased survival with AF and other forms of cardiovascular diseases.

AF is associated with a 1.5-2-fold increase in risk of death, with a 2-fold increase in sudden cardiac
death, 5-fold increase in heart failure, 2.4-fold increase in risk of stroke, 1.5-fold increase in the risk
of cognitive impairment or dementia and myocardial infarction, and a similar degree of increased
risk of chronic kidney disease and peripheral artery disease. This leads to an elevated burden on the
healthcare systems globally.

This 2023 update to the 2019 ACC/AHA/ACCP/HRS guidelines includes many key elements based on
the developments in the field of atrial fibrillation research over the past five years. The guidelines
view AF as a disease continuum that requires long-term preventive strategies, including lifestyle
changes, early screening, and risk factor management. The recommendations include management
of obesity, increased physical activity, smoking cessation, alcohol moderation, and management of
hypertension and other comorbidities.

Notably, the new guidelines, have updated the list of risk prediction tools that are currently used by
clinicians to guide their treatment strategies. The newly included risk scores are GARFIELD-AF,
ATRIA, and MCHA 2 DS 2 -VASc. The potential advantages of these newer scores include:

  • Prediction of mortality and bleeding risk which are not captured by the CHA 2 DS 2 -VASc score;
  • Incorporation of factors beyond those included in conventional risk scores, such as smoking
    status, and dementia, for improved risk prediction;
  • Assessment of the impact of anticoagulant treatment, to help clinicians to judge whether
    the benefits of anticoagulation outweigh the risks.

The GARFIELD-AF risk score was developed on patient data from the GARFIELD-AF registry, the
largest real-world longitudinal study on newly diagnosed AF patients. The study recruited more than
50,000 patients across 35 countries and had a follow-up of 24 months. The risk assessment tool is
freely available to clinicians, researchers, and patients worldwide at GARFIELD-AF Risk Calculator.
We have also partnered with QxMD to make this tool freely available to clinicians on iOS and

With the addition of the GARFIELD-AF Risk Calculator and other new risk assessment tools, clinicians
have more resources to critically assess their patients and provide them with bespoke treatment
strategies for AF management.

By Dr Sandeep Prakasam, Medical Writer

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