English (United Kingdom)

https://curated-unify.zendy.io/wp-json/zendy-region/v1/featured_content/oa?rat=en

https://curated-unify.zendy.io/wp-json/zendy-region/v1/highlighted_journal/

Global: Zendy Plus annual

Presents the access of premium content as premium feature

Premium Content

Presents the keyphrase highlighting as premium feature

Keyphrase Highlighting

Presents the summarisation as premium feature

Summarisation

Insights

Presents the pdf analysis as premium feature

PDF Analysis

Presents the zaia usage as premium feature

ZAIA

Global: Zendy Tools annual

Global: Zendy Free Plan

Global: Zendy Tools monthly

Global: Zendy Plus monthly

trial fibrillation (AF) is the most common sustained arrhythmia in humans and affects 1–2% of the general population worldwide. It affects 3 and 6 million people in the United States and Europe, respectively.1,2 Its incidence rises with age and the lifetime risk of AF development in those older than 40 years has been estimated to be approximately 25%.3 On the other hand, AF also affects a significant proportion of younger patients, with a prevalence of 0.7% in those aged between 55 and 59 years.4 These data were derived from population-based studies conducted in Western countries and the epidemiology picture in the Asia – Pacific region, which constitutes more than 50% of the global population, is less well studied. It has been estimated that the age-standardized prevalence of AF is 0.65% in China,5 and ranges from 0.7% to 1.5% in other Asian countries,6–8 which is slightly lower than that of Western countries. It is also expected that these figures will increase 2.5–3-fold during the next 50 years.1,9 AF doubles the risk of death and increases the risk of stroke by 5-fold. Although it commonly coexists with other cardiovascular disorders, it also adversely affects the prognosis of those with coronary artery disease,10 heart failure,11 or even hypertension.12 Management of AF is a complex issue. The last published guidelines for management of AF by the ACC/AHA/ESC were released in 2006.13 However, the adoption of those management guidelines into clinical practice was a real challenge and was limited by cultural, social and economic factors.14 Both patients and physicians may frequently ask the same question when facing AF: Is it better to be in sinus rhythm? The debate between rhythm and rate control has lasted for decades and lead to multiple randomized clinical trials testing the hypothesis that rhythm control is superior to rate control, as some cardiologists and electrophysiologists deeply believe, in achieving better clinical outcomes.15–21 What has been consistently observed in these clinical trials is that both strategies are equivalent if cardiovascular events, such as death or stroke, are chosen as the primary endpoints in patients at risk of stroke and with or without heart failure, provided appropriate antithrombotic therapy is offered to eligible patients. In other words, proper anticoagulation, instead of deciding on a rate or rhythm control strategy, is probably the key to lower cardiovascular events in these patients. The clinical implications of these findings are now translated into and emphasized in the latest management guidelines for AF published by the European Society of Cardiology this year.2 The guidelines clearly state that the 2 strategies are not mutually exclusive. The focus of AF management nowadays should shift from a focus on the rate or rhythm control decision to a comprehensive treatment plan for an individual; that is, don’t just look at the ECG but the whole patient! Evaluation of the thromboembolic risk in AF patients has become the top priority in the management algorithm, irrespective if at the acute stage or as a long-term objective.2 The most widely adopted assessment tool has been the CHADS2 score.22 It has been very useful in the primary care setting because it can be easily remembered by physicians and does not require any sophisticated investigations. Patients classified as high risk for thromboembolism (ie, CHADS2 score ≥2) should receive anticoagulation, whereas those at low or intermediate risk can receive either antiplatelet or oral anticoagulation (OAC) therapy. However, in a recent analysis of these schemes for assessing stroke risk, a substantial proportion of patients (>60%) were classified as intermediate risk and then a difficult decision about the ideal thromboprophylaxis will be encountered.23 In addition, female patients with a borderline age (eg, 65–74 years) and no other risk factor are, in fact, not truly at low risk, even though the CHADS2 score is still zero. To address this issue, a new assessment tool has been introduced in the new guidelines, namely, the CHA2DS2VASc score, which takes into account several important predictors of stroke in patients with non-valvular AF, such as age 65–74 years, female sex and coexisting vascular heart disease. It should not be considered as a brand new scheme, but rather a refined version. OAC is still recommended for those with CHADS2 score ≥2, but a detailed assessment with regards to the non-major but relevant risk factors is necessary for those with CHADS2 score 0 or 1. OAC is preferred for those with CHA2DS2VASc score of 1, but no antithrombotic therapy is recommended for CHA2DS2VASc score of 0. The new guidelines also stress the importance of bleeding risk assessment with the HAS-BLED scheme.2 Caution should be taken when prescribing OAC to those with a HAS-BLED score ≥3. Can we simply apply this new scheme to the whole world, including Asia-Pacific region? The answer is uncertain. There are major differences in stroke types among white and

The 2010 Update of the ESC Guidelines for the Management of Atrial Fibrillation - Beyond the Rate or Rhythm Strategy Debate -