{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,30]],"date-time":"2026-04-30T22:11:26Z","timestamp":1777587086282,"version":"3.51.4"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"4","license":[{"start":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T00:00:00Z","timestamp":1677628800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,4,15]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aims<\/jats:title><jats:p>The recent 4S-AF (scheme proposed by the 2020 ESC AF guidelines to address stroke risk, symptom severity, severity of AF burden and substrate of AF to provide a structured phenotyping of AF patients in clinical practice to guide therapy and assess prognosis) scheme has been proposed as a structured scheme to characterize patients with atrial fibrillation (AF). We aimed to assess whether the 4S-AF scheme predicts AF progression in patients with self-terminating AF.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>We analysed 341 patients with self-terminating AF included in the well-phenotyped Reappraisal of Atrial Fibrillation: Interaction between HyperCoagulability, Electrical remodelling, and Vascular Destabilization in the Progression of AF (RACE V) study. Patients had continuous monitoring with implantable loop recorders or pacemakers. AF progression was defined as progression to persistent or permanent AF or progression of self-terminating AF with &amp;gt;3% burden increase. Progression of AF was observed in 42 patients (12.3%, 5.9% per year). Patients were given a score based on the components of the 4S-AF scheme. Mean age was 65 [interquartile range (IQR) 58\u201371] years, 149 (44%) were women, 103 (49%) had heart failure, 276 (81%) had hypertension, and 38 (11%) had coronary artery disease. Median CHA2DS2-VASc (the CHA2DS2\u2013VASc score assesses thromboembolic risk. C, congestive heart failure\/left ventricular dysfunction; H, hypertension; A2, age \u2265 75 years; D, diabetes mellitus; S2, stroke\/transient ischaemic attack\/systemic embolism; V, vascular disease; A, age 65\u201374 years; Sc, sex category (female sex)) score was 2 (IQR 2\u20133), and median follow-up was 2.1 (1.5\u20132.6) years. The average score of the 4S-AF scheme was 4.6 \u00b1 1.4. The score points from the 4S-AF scheme did not predict the risk of AF progression [odds ratio (OR) 1.1 95% CI 0.88\u20131.41, C-statistic 0.53]. However, excluding the symptoms domain, resulting in the 3S-AF (4S-AF scheme without the domain symptom severity, only including stroke risk, severity of AF burden and substrate of AF) scheme, predicted the risk of progression (OR 1.59 95% CI 1.15\u20132.27, C-statistic 0.62) even after adjusting for sex and age.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In self-terminating AF patients, the 4S-AF scheme does not predict AF progression. The 3S-AF scheme, excluding the symptom domain, may be a more appropriate score to predict AF progression.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration numbers<\/jats:title><jats:p>Clinicaltrials.gov NCT02726698 for RACE V<\/jats:p><\/jats:sec>","DOI":"10.1093\/europace\/euac268","type":"journal-article","created":{"date-parts":[[2023,3,1]],"date-time":"2023-03-01T18:18:07Z","timestamp":1677694687000},"page":"1323-1331","source":"Crossref","is-referenced-by-count":13,"title":["Clinical utility of the 4S-AF scheme in predicting progression of atrial fibrillation: data from the RACE V study"],"prefix":"10.1093","volume":"25","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3043-1675","authenticated-orcid":false,"given":"Vicente","family":"Artola Arita","sequence":"first","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6003-5999","authenticated-orcid":false,"given":"Martijn E","family":"Van De Lande","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Neda","family":"Khalilian Ekrami","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6043-4172","authenticated-orcid":false,"given":"Bao-Oanh","family":"Nguyen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4282-4628","authenticated-orcid":false,"given":"Joost M","family":"Van Melle","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bastiaan","family":"Geelhoed","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ruben R","family":"De With","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2901-6383","authenticated-orcid":false,"given":"Vanessa","family":"Webernd\u00f6rfer","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre + , Maastricht , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2786-1308","authenticated-orcid":false,"given":"\u00d6mer","family":"Erk\u00fcner","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre + , Maastricht , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7397-1148","authenticated-orcid":false,"given":"Hans","family":"Hillege","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"},{"name":"Department of Epidemiology, University Medical Centre Groningen, University of Groningen , Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4893-0824","authenticated-orcid":false,"given":"Dominik","family":"Linz","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre + , Maastricht , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Centre , Nijmegen , The Netherlands"},{"name":"Centre for Heart Rhythm Disorders, University of Adelaide and Royal Adelaide Hospital , Adelaide , Australia"},{"name":"Department of Biomedical Sciences, Faculty of Health and Medical Sciences, University of Copenhagen , Copenhagen , Denmark"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7796-4463","authenticated-orcid":false,"given":"Hugo","family":"Ten Cate","sequence":"additional","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht, Departments of Biochemistry , Maastricht , The Netherlands"},{"name":"Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"},{"name":"Maastricht University Medical Center+ , Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3858-334X","authenticated-orcid":false,"given":"Henri M H","family":"Spronk","sequence":"additional","affiliation":[{"name":"Thrombosis Expertise Center (TEC) Maastricht, Departments of Biochemistry , Maastricht , The Netherlands"},{"name":"Internal Medicine, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"},{"name":"Maastricht University Medical Center+ , Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0321-3410","authenticated-orcid":false,"given":"Tim","family":"Koldenhof","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"},{"name":"Department of Cardiology, Martini Hospital , Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7654-2098","authenticated-orcid":false,"given":"Robert G","family":"Tieleman","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"},{"name":"Department of Cardiology, Martini Hospital , Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1532-3315","authenticated-orcid":false,"given":"Ulrich","family":"Schotten","sequence":"additional","affiliation":[{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"},{"name":"Department of Cardiology, Radboud University Medical Centre , Nijmegen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1073-5337","authenticated-orcid":false,"given":"Harry J G M","family":"Crijns","sequence":"additional","affiliation":[{"name":"Department of Cardiology, Maastricht University Medical Centre + , Maastricht , The Netherlands"},{"name":"Cardiovascular Research Institute Maastricht (CARIM), Maastricht University , Maastricht , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Isabelle C","family":"Van Gelder","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2581-070X","authenticated-orcid":false,"given":"Michiel","family":"Rienstra","sequence":"additional","affiliation":[{"name":"Department of Cardiology, University of Groningen, University Medical Centre Groningen , Hanzeplein 1, Groningen , The Netherlands"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2023,3,1]]},"reference":[{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"801","DOI":"10.1016\/j.hrthm.2017.01.038","article-title":"Progression of paroxysmal to persistent atrial fibrillation: 10-year follow-up in the Canadian registry of atrial fibrillation","volume":"14","author":"Padfield","year":"2017","journal-title":"Heart Rhythm"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"1608","DOI":"10.1136\/heartjnl-2017-312569","article-title":"Atrial fibrillation patterns are associated with arrhythmia progression and clinical outcomes","volume":"104","author":"Schnabel","year":"2018","journal-title":"Heart"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"1455","DOI":"10.1093\/europace\/euw161","article-title":"EHRA\/HRS\/APHRS\/SOLAECE expert consensus on atrial cardiomyopathies: definition, 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Cardiol"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"288","DOI":"10.1093\/eurheartj\/ehu359","article-title":"Higher risk of death and stroke in patients with persistent vs. paroxysmal atrial fibrillation: results from the ROCKET-AF trial","volume":"36","author":"Steinberg","year":"2015","journal-title":"Eur Heart J"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"929","DOI":"10.1093\/europace\/eux217","article-title":"The influence of progression of atrial fibrillation on quality of life: a report from the euro heart survey","volume":"20","author":"Dudink","year":"2018","journal-title":"Europace"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"813","DOI":"10.1007\/s00392-017-1123-0","article-title":"Clinical scores for outcomes of rhythm control or arrhythmia progression in patients with atrial fibrillation: a systematic review","volume":"106","author":"Deng","year":"2017","journal-title":"Clin Res Cardiol"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"1162","DOI":"10.1093\/europace\/euaa123","article-title":"Temporal patterns and short-term progression of paroxysmal atrial fibrillation: data from RACE V","volume":"22","author":"De With","year":"2020","journal-title":"Europace"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1093\/eurheartj\/ehaa612","article-title":"2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS)","volume":"42","author":"Hindricks","year":"2021","journal-title":"Eur Heart J"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"270","DOI":"10.1055\/s-0040-1716408","article-title":"The 4S-AF scheme (stroke risk; symptoms; severity of burden; substrate): a novel approach to in-depth characterization (rather than classification) of atrial fibrillation","volume":"121","author":"Potpara","year":"2021","journal-title":"Thromb Haemost"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"721","DOI":"10.1093\/europace\/euab280","article-title":"Clinical utility and prognostic implications of the novel 4S-AF scheme to characterize and evaluate patients with atrial fibrillation: a report from ESC-EHRA EORP-AF long-term general registry","volume":"24","author":"Ding","year":"2022","journal-title":"Europace"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1016\/j.echo.2016.09.007","article-title":"Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis","volume":"30","author":"Pathan","year":"2017","journal-title":"J Am Soc Echocardiogr"},{"key":"2023041606535686700_","doi-asserted-by":"crossref","first-page":"202","DOI":"10.1093\/europace\/euab202","article-title":"Characterization of atrial fibrillation in 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