The 4S-AF Scheme (Stroke Risk; Symptoms; Severity of Burden; Substrate): A Novel Approach to In-Depth Characterization (Rather than Classification) of Atrial Fibrillation

Abstract Atrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity....

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Published in:Thrombosis and haemostasis Vol. 121; no. 3; pp. 270 - 278
Main Authors: Potpara, Tatjana S., Lip, Gregory Y. H., Blomstrom-Lundqvist, Carina, Boriani, Giuseppe, Van Gelder, Isabelle C., Heidbuchel, Hein, Hindricks, Gerhard, Camm, Alan John
Format: Journal Article
Language:English
Published: Rüdigerstraße 14, 70469 Stuttgart, Germany Georg Thieme Verlag KG 01.03.2021
Subjects:
Animals
Atrial Fibrillation - complications
Atrial Fibrillation - diagnosis
Atrial Fibrillation - physiopathology
Atrial Fibrillation - therapy
Disease Management
Humans
Prognosis
Review Article
Risk Factors
Severity of Illness Index
Stroke - etiology
atrial fibrillation
classification scheme
symptom severity
stroke risk
temporal-based classification
characterization
substrate
burden
ISSN:0340-6245, 2567-689X, 2567-689X
Online Access:Get full text
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Summary:Abstract Atrial fibrillation (AF) is a complex condition requiring holistic management with multiple treatment decisions about optimal thromboprophylaxis, symptom control (and prevention of AF progression), and identification and management of concomitant cardiovascular risk factors and comorbidity. Sometimes the information needed for treatment decisions is incomplete, as available classifications of AF mostly address a single domain of AF (or patient)-related characteristics. The most widely used classification of AF based on AF episode duration and temporal patterns (that is, the classification to first-diagnosed, paroxysmal, persistent/long-standing persistent, and permanent AF) has contributed to a better understanding of AF prevention and treatment but its limitations and the need for a multidimensional AF classification have been recognized as more complex treatment options became available. We propose a paradigm shift from classification toward a structured characterization of AF, addressing specific domains having treatment and prognostic implications to become a standard in clinical practice, thus aiming to streamline the assessment of AF patients at all health care levels facilitating communication among physicians, treatment decision-making, and optimal risk evaluation and management of AF patients. Specifically, we propose the 4S-AF structured pathophysiology-based characterization (rather than classification) scheme that includes four AF- and patient-related domains—Stroke risk, Symptoms, Severity of AF burden, and Substrate severity—and provide a hypothetical model for the use of 4S-AF characterization scheme to aid treatment decision making concerning the management of patients with AF in clinical practice.
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ISSN:0340-6245
2567-689X
2567-689X
DOI:10.1055/s-0040-1716408