A new study has found that a novel tool that simultaneously assesses the risk of all-cause mortality, stroke or embolism, and major bleeding in patients with atrial fibrillation (AF) outperforms current risk calculators.
The GARFIELD-AF risk tool was evaluated using UK primary care electronic records of nearly half a million patients, linked with hospital episode data and mortality data.
Anticoagulation reduces the risk of AF-related strokes but carries an increased risk of bleeding. Guidelines recommend using the CHA2DS2VASc score to assess stroke risk, and the HAS-BLED or ORBIT-AF scores to assess bleeding risk.
The study found that GARFIELD-AF was superior to CHA2DS2VASc scores for predicting stroke and to HAS-BLED scores for predicting bleeding. However, the tool consistently underestimated risk of stroke or bleeding events.
Nonetheless, it is the only calculator that not only assesses stroke and bleeding risks in patients with AF, but also death, for which there is no currently recommended tool.
The study’s authors believe that, with further ‘calibration’ it could be used in UK clinical practice to improve decision-making regarding anticoagulation for patients with AF.
Apenteng PN, et al. Br J Gen Pract 2023;73(736):e816-e824
