This systematic review (SR) and meta-analysis updates a 2013 report published by the Agency for Healthcare Research and Quality’s Effective Healthcare Program, which evaluated questions related to stroke prevention in patients with atrial fibrillation and atrial flutter. Atrial fibrillation is an irregular heartbeat that can lead to blood clots, stroke, heart failure, and other complications. In atrial flutter, the upper chambers of the heart beat too fast, which results in atrial muscle contractions that are faster than and out of sync with the lower chambers.
Within this systematic review, we will use AF to include patients with either atrial fibrillation and atrial flutter. AF is the most common heart arrhythmia seen in clinical practice. Management of AF involves rate control, rhythm control, and prevention of thromboembolic events. This review update focuses on prevention of thromboembolic events. The key questions (KQs) for this systematic review update derive from the original review and have been updated based on stakeholder feedback obtained by PCORI.
The key questions are: 1) In patients with nonvalvular atrial fibrillation, what are the comparative diagnostic accuracy and impact on clinical decisionmaking (diagnostic thinking, therapeutic and patient outcome efficacy) of available clinical and imaging tools and associated risk factors for predicting thromboembolic risk? 2) In patients with nonvalvular atrial fibrillation, what are the comparative diagnostic accuracy and impact on clinical decisionmaking (diagnostic thinking, therapeutic, and patient outcome efficacy) of clinical tools and associated risk factors for predicting bleeding events? 3) What are the comparative safety and effectiveness of specific anticoagulation therapies, antiplatelet therapies, and procedural interventions for preventing thromboembolic events: a.In patients with nonvalvular atrial fibrillation?, and b.In specific subpopulations of patients with nonvalvular atrial fibrillation?
The review also asks a contextual question, which is not systematically reviewed but uses a "best evidence" approach: What are currently available shared decision-making tools for patient and provider use for stroke prophylaxis in atrial fibrillation, and what are their relative strengths and weaknesses?