Curr Probl Cardiol. 2025 Nov 27:103231. doi: 10.1016/j.cpcardiol.2025.103231. Online ahead of print.
ABSTRACT
Atrial fibrillation (AF) and heart failure (HF) frequently coexist, which leads to adverse clinical outcomes and a significant increase in the risk of both ischemic stroke and major bleeding. Although still valuable due to their widespread adoption, traditional risk scores (e.g. CHADS-VASc, HAS-BLED) may not adequately capture group-specific differences in the context of substantial therapeutic and demographic changes that have occurred in recent years. This review summarizes emerging risk factors for stroke and bleeding, focusing on clinical and structural markers, and highlighting the novel biomarker-based approach. Factors such as chronic kidney disease, poor nutritional status, metabolic-associated fatty liver disease, frailty, and polypharmacy appear to substantially modify the risk. Biomarkers, including natriuretic peptides, high-sensitivity cardiac troponins, and growth differentiation factor-15, along with various markers of inflammation and hypercoagulability, provide valuable prognostic information. Incorporating echocardiographic measures, such as left atrial size, morphology, and appendage flow, together with electrocardiographic factors, including AF type and episode duration, may further refine stroke and bleeding prediction. New risk models, such as those based on novel biomarker strategies and machine learning, offer promising results in predicting stroke and bleeding when compared to traditional and well-validated risk scores. A better understanding and integration of these emerging risk factors can enhance existing risk stratification tools, guiding clinicians toward a more individualized decision-making process, while improving strategies for preventing stroke and major bleeding in this specific and vulnerable population.
PMID:41318013 | DOI:10.1016/j.cpcardiol.2025.103231