ATRIAL FIBRILLATION AND STROKE RISK: PREVENTION STRATEGIES AND PUBLIC HEALTH IMPLICATIONS

Natalia Matylda Ziemba-Furgała; Agnieszka  Szwed; Katarzyna Anna Borzęcka; Ewa Maria Polewczak-Karp; Daria Aleksandra  Warzocha-Żurek; Krystian  Andryszko; Aleksandra  Sołtys; Marcelina  Dymon; Paulina  Krysa; Katarzyna  Wawrzonek

doi:10.31435/ijitss.2(50).2026.5447

Authors

Natalia Matylda Ziemba-Furgała Ministry of the Interior and Administration Hospital in Rzeszow, Krakowska 16, 35-111 Rzeszow, Poland https://orcid.org/0009-0009-5031-3930
Agnieszka Szwed MSWiA Hospital, Krakowska 16, 35-111 Rzeszow, Poland https://orcid.org/0009-0003-6395-5365
Katarzyna Anna Borzęcka Medical Center in Łańcut Sp. z o.o., Ignacego Paderewskiego 5, 37-100 Łańcut, Poland https://orcid.org/0009-0007-4084-4370
Ewa Maria Polewczak-Karp Medical Center in Łańcut Sp. z o.o., Ignacego Paderewskiego 5, 37-100 Łańcut, Poland https://orcid.org/0009-0006-6411-4826
Daria Aleksandra Warzocha-Żurek Clinical Provincial Hospital in Rzeszow, Lwowska 60, 35-301 Rzeszow, Poland https://orcid.org/0009-0005-5756-2404
Krystian Andryszko Clinical Regional Hospital of Saint Jadwiga The Queen in Rzeszów, Lwowska 60, 35-301 Rzeszów, Poland https://orcid.org/0009-0006-6170-5663
Aleksandra Sołtys University of Rzeszow, Poland https://orcid.org/0009-0007-2557-2696
Marcelina Dymon University of Rzeszow, Poland https://orcid.org/0009-0000-8008-7932
Paulina Krysa City Hospital of John Paul II in Rzeszów, Rycerska 4, 35-241 Rzeszów, Poland https://orcid.org/0009-0000-6633-3586
Katarzyna Wawrzonek Clinical Provincial Hospital of Saint Jadwiga the Queen in Rzeszow, Poland https://orcid.org/0009-0007-6883-422X

DOI:

https://doi.org/10.31435/ijitss.2(50).2026.5447

Keywords:

Atrial Fibrillation, Stroke, Prevention, Public Health, Anticoagulation, CHA₂DS₂-VASc, HAS-BLED

Abstract

Atrial fibrillation is the most common sustained cardiac arrhythmia and a major risk factor for stroke. The aim of this review is to present the relationship between AF and stroke risk through an analysis of current epidemiological data, pathophysiological mechanisms, risk factors, and prevention strategies.

This review is based on an analysis of recent literature and clinical guidelines. Patients with atrial fibrillation have a significantly increased risk of stroke, which is often associated with greater severity and poorer outcomes. Risk stratification tools such as CHA₂DS₂-VASc and HAS-BLED play a key role in guiding individualized therapy. Anticoagulation remains the cornerstone of stroke prevention, supported by management of risk factors and lifestyle modification. Early detection, particularly in asymptomatic patients, is also crucial.

Despite the availability of effective preventive strategies, their implementation in clinical practice remains suboptimal. Effective stroke prevention requires an integrated approach combining risk assessment, appropriate treatment, and early diagnosis.

References

Abed, H. S., Wittert, G. A., Leong, D. P., Shirazi, M. G., Bahrami, B., Middeldorp, M. E., et al. (2013). Effect of weight reduction and risk factor management. JAMA, 310(19), 2050–2060. https://doi.org/10.1001/jama.2013.280521

Benjamin, E. J., Muntner, P., Alonso, A., Bittencourt, M. S., Callaway, C. W., Carson, A. P., et al. (2019). Heart disease and stroke statistics—2019 update: A report from the American Heart Association. Circulation, 139(10), e56–e528. https://doi.org/10.1161/CIR.0000000000000659

Calkins, H., Hindricks, G., Cappato, R., Kim, Y. H., Saad, E. B., Aguinaga, L., et al. (2017). HRS/EHRA/ECAS consensus on catheter ablation. Heart Rhythm, 14(10), e275–e444. https://doi.org/10.1016/j.hrthm.2017.05.012

Chugh, S. S., Havmoeller, R., Narayanan, K., Singh, D., Rienstra, M., Benjamin, E. J., et al. (2014). Worldwide epidemiology of atrial fibrillation: A global burden of disease 2010 study. Circulation, 129(8), 837–847. https://doi.org/10.1161/CIRCULATIONAHA.113.005119

Freedman, B., Camm, J., Calkins, H., Healey, J. S., Rosenqvist, M., Wang, J., et al. (2017). Screening for atrial fibrillation: A report of the AF-SCREEN Collaboration. Circulation, 135(19), 1851–1867. https://doi.org/10.1161/CIRCULATIONAHA.116.026693

Granger, C. B., Alexander, J. H., McMurray, J. J. V., Lopes, R. D., Hylek, E. M., Hanna, M., et al. (2011). Apixaban versus warfarin in patients with atrial fibrillation. New England Journal of Medicine, 365(11), 981–992. https://doi.org/10.1056/NEJMoa1107039

Hart, R. G., Pearce, L. A., & Aguilar, M. I. (2007). Meta-analysis: Antithrombotic therapy to prevent stroke in atrial fibrillation. Annals of Internal Medicine, 146(12), 857–867. https://doi.org/10.7326/0003-4819-146-12-200706190-00007

Hindricks, G., Potpara, T., Dagres, N., Arbelo, E., Bax, J. J., Blomström-Lundqvist, C., et al. (2020). 2020 ESC guidelines for the diagnosis and management of atrial fibrillation. European Heart Journal, 42(5), 373–498. https://doi.org/10.1093/eurheartj/ehaa612

Holmes, D. R., Kar, S., Price, M. J., Whisenant, B., Sievert, H., Doshi, S. K., et al. (2015). Left atrial appendage closure long-term outcomes. Journal of the American College of Cardiology, 65(24), 2614–2623. https://doi.org/10.1016/j.jacc.2015.04.025

January, C. T., Wann, L. S., Calkins, H., Chen, L. Y., Cigarroa, J. E., Cleveland, J. C., et al. (2019). 2019 AHA/ACC/HRS focused update of atrial fibrillation guidelines. Circulation, 140(2), e125–e151. https://doi.org/10.1161/CIR.0000000000000665

Krijthe, B. P., Kunst, A., Benjamin, E. J., Lip, G. Y. H., Franco, O. H., Hofman, A., et al. (2013). Projections on the number of individuals with atrial fibrillation in the European Union. European Heart Journal, 34(35), 2746–2751. https://doi.org/10.1093/eurheartj/eht280

Lamassa, M., Di Carlo, A., Pracucci, G., Basile, A. M., Trefoloni, G., Vanni, P., et al. (2001). Characteristics, outcome, and care of stroke associated with atrial fibrillation. Stroke, 32(2), 392–398. https://doi.org/10.1161/01.STR.32.2.392

Lavie, C. J., Pandey, A., Lau, D. H., Alpert, M. A., & Sanders, P. (2017). Obesity and atrial fibrillation prevalence. Journal of the American College of Cardiology, 70(16), 2022–2035. https://doi.org/10.1016/j.jacc.2017.09.002

Lip, G. Y. H., Nieuwlaat, R., Pisters, R., Lane, D. A., & Crijns, H. J. G. M. (2010). Refining clinical risk stratification for predicting stroke and thromboembolism. Chest, 137(2), 263–272. https://doi.org/10.1378/chest.09-1584

Marini, C., De Santis, F., Sacco, S., Russo, T., Olivieri, L., Totaro, R., et al. (2005). Contribution of atrial fibrillation to incidence and outcome of ischemic stroke. Stroke, 36(6), 1115–1119. https://doi.org/10.1161/01.STR.0000166053.83476.4a

Ogilvie, I. M., Newton, N., Welner, S. A., Cowell, W., & Lip, G. Y. H. (2010). Underuse of oral anticoagulants in atrial fibrillation. American Journal of Medicine, 123(7), 638–645. https://doi.org/10.1016/j.amjmed.2009.11.025

Patel, M. R., Mahaffey, K. W., Garg, J., Pan, G., Singer, D. E., Hacke, W., et al. (2011). Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. New England Journal of Medicine, 365(10), 883–891. https://doi.org/10.1056/NEJMoa1009638

Pathak, R. K., Middeldorp, M. E., Meredith, M., Mehta, A. B., Mahajan, R., Wong, C. X., et al. (2015). Long-term effect of goal-directed weight management in AF. Journal of the American College of Cardiology, 65(20), 2159–2169. https://doi.org/10.1016/j.jacc.2015.03.002

Pisters, R., Lane, D. A., Nieuwlaat, R., de Vos, C. B., Crijns, H. J. G. M., & Lip, G. Y. H. (2010). A novel user-friendly score (HAS-BLED) to assess bleeding risk. Chest, 138(5), 1093–1100. https://doi.org/10.1378/chest.10-0134

Reddy, V. Y., Doshi, S. K., Sievert, H., Buchbinder, M., Neuzil, P., Huber, K., et al. (2014). Left atrial appendage closure vs. warfarin. JAMA, 312(19), 1988–1998. https://doi.org/10.1001/jama.2014.15192

Ruff, C. T., Giugliano, R. P., Braunwald, E., Hoffman, E. B., Deenadayalu, N., Ezekowitz, M. D., et al. (2014). Comparison of NOACs with warfarin. The Lancet, 383(9921), 955–962. https://doi.org/10.1016/S0140-6736(13)62343-0

Sanna, T., Diener, H. C., Passman, R. S., Di Lazzaro, V., Bernstein, R. A., Morillo, C. A., et al. (2014). Cryptogenic stroke and underlying atrial fibrillation. New England Journal of Medicine, 370(26), 2478–2486. https://doi.org/10.1056/NEJMoa1313600

Stewart, S., Hart, C. L., Hole, D. J., & McMurray, J. J. V. (2004). Population prevalence, incidence, and predictors of atrial fibrillation. Heart, 90(2), 145–150. https://doi.org/10.1136/heart.2002.007450

World Health Organization. (2020). Guidelines on physical activity and sedentary behaviour. https://www.who.int/publications/i/item/9789240015128

Zoni-Berisso, M., Lercari, F., Carazza, T., & Domenicucci, S. (2014). Epidemiology of atrial fibrillation: European perspective. Clinical Epidemiology, 6, 213–220. https://doi.org/10.2147/CLEP.S47385