动态评分重估对房颤患者卒中和出血风险结局预测有何影响?

IF 2.1 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS
Eva Soler-Espejo, Francisco Marín, Vanessa Roldán, José Miguel Rivera-Caravaca
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引用次数: 0

摘要

动态重新评估卒中和出血风险是心房颤动(AF)管理中以患者为中心的护理的基石。与仅在诊断或开始口服抗凝治疗时评估这些风险的传统方法不同,目前的证据强调由于风险性质的不断变化而定期重新评估。涉及领域:房颤患者的卒中和出血风险受年龄、新的合并症和健康状况恶化的影响,需要更新管理计划以优化结果。CHA2DS2-VASc(或无性别CHA2DS2-VA)和ha - bled评分的动态升高与卒中和出血风险增加相关,强调需要定期重新评估。解决可改变的危险因素,如高血压、肾功能不全和同时用药是改善预后的关键。尽管一些指导方针现在建议至少每年进行一次风险重新评估,但最佳时间仍不清楚。证据支持对低风险卒中患者(每4个月)和高风险出血患者(4-6周)进行更频繁的重新评估,以及时发现需要干预的变化。专家意见:尽管有好处,但风险再评估方面的挑战仍然存在,包括缺乏普遍适用的间隔时间和多学科评估的复杂性。人工智能工具的未来发展有望通过实现更精确、个性化和动态的患者管理来加强风险重新评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
What is the impact of dynamic score reassessment for stroke and bleeding risk outcome prediction in atrial fibrillation patients?

Introduction: Dynamic reassessment of stroke and bleeding risks is a cornerstone of patient-centered care in atrial fibrillation (AF) management. Unlike traditional approaches that evaluate these risks only at diagnosis or at initiation of oral anticoagulation, current evidence emphasizes periodic reassessment due to the evolving nature of risks.

Areas covered: Stroke and bleeding risks in AF patients are influenced by aging, new comorbidities, and worsening health conditions, requiring updates to management plans to optimize outcomes. Dynamic increases in CHA2DS2-VASc (or the sex-less CHA2DS2-VA) and HAS-BLED scores are associated with heightened risks of stroke and bleeding, underscoring the need for regular reassessment. Addressing modifiable risk factors such as hypertension, renal dysfunction, and concurrent medications is key to improving outcomes. Although several guidelines now recommend risk reassessment at least annually, optimal timing remains unclear. Evidence supports more frequent reassessments for low-risk stroke patients (every 4 months) and high-risk bleeding patients (within 4-6 weeks) to promptly identify changes requiring intervention.

Expert opinion: Despite its benefits, challenges remain regarding risk reassessment, including the lack of universally applicable intervals and the complexity of multidisciplinary evaluations. Future advancements in artificial intelligence tools are expected to enhance risk reassessment by enabling more precise, personalized, and dynamic patient management.

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来源期刊
Expert Review of Cardiovascular Therapy
Expert Review of Cardiovascular Therapy CARDIAC & CARDIOVASCULAR SYSTEMS-
CiteScore
3.70
自引率
0.00%
发文量
82
期刊介绍: Expert Review of Cardiovascular Therapy (ISSN 1477-9072) provides expert reviews on the clinical applications of new medicines, therapeutic agents and diagnostics in cardiovascular disease. Coverage includes drug therapy, heart disease, vascular disorders, hypertension, cholesterol in cardiovascular disease, heart disease, stroke, heart failure and cardiovascular surgery. The Expert Review format is unique. Each review provides a complete overview of current thinking in a key area of research or clinical practice.
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