Background and Disease Burden
Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia globally, affecting millions and significantly increasing the risk of ischemic stroke and mortality. Effective stroke prevention with oral anticoagulation (OAC) is established as the cornerstone in AF management. Yet, balancing stroke risk reduction against bleeding complications remains a clinical challenge. Traditional clinical risk scores, such as CHA2DS2-VASc for stroke and HAS-BLED for bleeding, are widely used but have limitations in individual patient risk discrimination.
Recent advances propose the use of biomarkers combined with clinical variables to create more precise risk stratification models. The ABC-AF (Age, Biomarkers, Clinical history in AF) risk score integrates cardiac biomarkers like N-terminal pro B-type natriuretic peptide (NT-proBNP), cardiac troponins, and growth differentiation factor-15 (GDF-15) alongside clinical factors to better predict stroke, bleeding, and death risks. While these biomarker-based scores show promise in retrospective validations, their prospective utility to guide tailored therapeutic decisions remains insufficiently tested.
