Atrial fibrillation and thromboprophylaxis in heart failure: the need for patient-centered approaches to address adherence

Caleb Ferguson,1 Sally C Inglis,1 Phillip J Newton,1 Sandy Middleton,2,3 Peter S Macdonald,3,4 Patricia M Davidson1,31Center for Cardiovascular and Chronic Care, University of Technology, 2National Center for Clinical Outcomes Research (NaCCOR), Australian Catholic University, 3St Vincent's Hospital, Darlinghurst, Sydney, Australia; 4Victor Chang Cardiac Research Institute, University of New South Wales, Sydney, AustraliaAbstract: Atrial fibrillation is a common arrhythmia in heart failure and a risk factor for stroke. Risk assessment tools can assist clinicians with decision making in the allocation of thromboprophylaxis. This review provides an overview of current validated risk assessment tools for atrial fibrillation and emphasizes the importance of tailoring individual risk and the importance of weighing the benefits of treatment. Further, this review provides details of innovative and patient-centered methods for ensuring optimal adherence to prescribed therapy. Prior to initiating oral anticoagulant therapy, a comprehensive risk assessment should include evaluation of associated cardiogeriatric conditions, potential for adherence to prescribed therapy, frailty, and functional and cognitive ability.Keywords: stroke risk, heart failure, atrial fibrillation, anticoagulation, risk stratification, medication adherence