Atrial fibrillation burden: A factor affecting direct oral anticoagulant use

This article discusses the issue of personalized approach for anticoagulants choice according to the atrial fibrillation burden (AFB), primarily in patients with subclinical atrial fibrillation (SCAF), i.e., atrial fibrillation (AF), which is identified using various cardiac implanted or wearable devices, but not on the electrocardiogram. There is some epidemiological evidence that the issue of AF as one of major risk factors for stroke and/or systemic embolism (SE) is becoming more prominent. Various interpretations of the term “AFB” are considered, and the data regarding its clinical significance are presented in detail. Current approaches to the prescription of direct oral anticoagulants (DOACs) in patients with SCAF according to the estimated risk of stroke/SE, and the known history of stroke or transient ischemic attack (TIA) are discussed. The results of the data analysis for subjects of the randomized clinical trial (RCT) evaluating the efficacy of DOAC use in patients with SCAF are considered. The data on the prognostic role of AFB in patients with AF including those with heart failure and reduced left ventricular ejection fraction are presented. The authors address the issue of DOAC choice in patients with SCAF, as well as the significance of once-daily DOACs in this situation. The cost-effectiveness of DOAC use for stroke and/or TIA prevention in patients with SCAF, which largely depends on the cost of therapy, is discussed.