{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,10]],"date-time":"2026-04-10T07:12:51Z","timestamp":1775805171101,"version":"3.50.1"},"reference-count":30,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"4","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2026,2,17]]},"abstract":"<jats:sec xml:lang=\"en\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p xml:lang=\"en\">The competing risk of nonstroke mortality may limit the potential benefit of stroke prophylaxis therapy in patients with atrial fibrillation or atrial flutter AF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Using a Medicare 20% sample, we identified a cohort of beneficiaries diagnosed with atrial fibrillation or atrial flutter from 2006 to 2019 using\n                      <jats:italic toggle=\"no\">International Classification of Diseases, Ninth Revision<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"no\">ICD\u20109<\/jats:italic>\n                      ) and\n                      <jats:italic toggle=\"no\">Tenth Revision<\/jats:italic>\n                      (\n                      <jats:italic toggle=\"no\">ICD\u201010<\/jats:italic>\n                      ) codes. Fine and Gray regression analysis determined the hazard of stroke with a competing risk of nonstroke mortality, and Cox proportional hazard analysis determined risk of nonstroke mortality. A scoring tool stratified patients into low or high potential benefit for thromboembolic prophylaxis.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p xml:lang=\"en\">\n                      Among a total of 1\u2009883\u2009759 Medicare beneficiaries, 330\u2009136 patients were included with median age of 79.7\u2009years. 54% of patients had prior bleeding episodes. The median CHA\n                      <jats:sub>2<\/jats:sub>\n                      DS\n                      <jats:sub>2<\/jats:sub>\n                      \u2010VASc score was 5. Of these patients, 211\u2009791 (64%) died and 77\u2009717 (24%) experienced an embolic stroke over median follow\u2010up of 7.3\u2009years. In the high potential benefit group (26.1%), the risk of stroke was much higher than the risk of nonstroke mortality at 1\u2009year (12.2% versus 7.1%); 3\u2009years (22.7% versus 16.9%); 5\u2009years (31.9% versus 26.1%). In the low potential benefit group (73.9%), the risk of stroke was much lower than the risk of nonstroke mortality at 1\u2009year (11.5% versus 39.2%); 3\u2009years (23.2 versus 57.2%); and 5\u2009years (34.3% versus 69.4%).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec xml:lang=\"en\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p xml:lang=\"en\">We propose a scoring tool to identify the potential benefit of thromboembolic prophylaxis therapy in older patients diagnosed with atrial fibrillation or atrial flutter. This tool can be used in shared decision\u2010making settings. Further studies to improve and validate this scoring tool are warranted.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1161\/jaha.125.044151","type":"journal-article","created":{"date-parts":[[2026,2,3]],"date-time":"2026-02-03T13:29:32Z","timestamp":1770125372000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Assessing Potential Benefit of Stroke Prophylaxis Therapy in Atrial Fibrillation and Atrial Flutter Using a Novel Competing Risk Scoring Tool"],"prefix":"10.1161","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2036-9254","authenticated-orcid":false,"given":"Anthony J.","family":"Mazzella","sequence":"first","affiliation":[{"name":"University of North Carolina at Chapel Hill","place":["Chapel Hill, USA"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-2587-8264","authenticated-orcid":false,"given":"Thomas 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