{
  "release_id": "5dcd9b263fe17744",
  "id": "cardio:pathway-af-stroke-prevention",
  "owner": "cardio",
  "kind": "care_pathway",
  "slug": "pathway-af-stroke-prevention",
  "name": "Stroke prevention in atrial fibrillation",
  "aliases": [],
  "atlases": [
    "cardio"
  ],
  "summary_plain": "The steps that an ACC summary of the 2023 guideline gives for lowering stroke risk in atrial fibrillation: estimate the risk with a validated score, base stroke-reducing treatment on that risk, favor a direct oral anticoagulant, do not swap in aspirin, and consider a catheter device that closes the left atrial appendage in some patients who cannot take blood thinners or have a high bleeding risk on them.",
  "summary_technical": "Care pathway built only from the ACC key-perspectives summary of the guideline (hash only, cite only), not the guideline text. Each step cites one claim, which carries its own limits. The summary prints classes of recommendation only for the appendage occlusion step. It also covers bleeding risk scores, device-detected episodes and combined treatment with coronary artery disease, which are not recorded here. PubMed lists three corrections to the guideline; their text was not read.",
  "editorial_state": "draft",
  "last_substantive_edit": "2026-10-15",
  "last_evidence_check": "2026-10-15",
  "next_review_due": null,
  "identifiers": [],
  "navigation": {
    "cardio": {
      "system": [
        "heart",
        "brain"
      ],
      "condition-area": [
        "arrhythmias",
        "stroke"
      ]
    }
  },
  "payload": {
    "applicability": "cardio:ctx-acc-aha-2023-patients-with-af",
    "steps": [
      {
        "label": "Estimate stroke and thromboembolism risk",
        "description": "The guideline endorses a validated clinical risk score and gives CHA2DS2-VASc, ATRIA and GARFIELD-AF as examples.",
        "branch_condition": null,
        "claims": [
          "cardio:claim-acc-aha-2023-af-risk-score"
        ]
      },
      {
        "label": "Base stroke-reducing therapy on that risk",
        "description": "When the estimated yearly chance of a stroke or thromboembolic event is 2% or more, therapy follows that chance, not the pattern of atrial fibrillation.",
        "branch_condition": "Yearly stroke or thromboembolism risk, as estimated, of 2% or more",
        "claims": [
          "cardio:claim-acc-aha-2023-af-risk-based-anticoagulation"
        ]
      },
      {
        "label": "Choose the anticoagulant",
        "description": "Direct oral anticoagulants rather than warfarin are favored.",
        "branch_condition": "Does not apply to mitral stenosis or a mechanical heart valve",
        "claims": [
          "cardio:claim-acc-aha-2023-af-doac-preferred"
        ]
      },
      {
        "label": "Do not use aspirin in place of an anticoagulant",
        "description": "Aspirin alone, or with clopidogrel, is not recommended as a substitute for anticoagulation to prevent stroke.",
        "branch_condition": "Patients who could take an anticoagulant and have no other reason for antiplatelet therapy",
        "claims": [
          "cardio:claim-acc-aha-2023-af-aspirin-not-alternative"
        ]
      },
      {
        "label": "Consider left atrial appendage occlusion",
        "description": "A catheter device that closes off the left atrial appendage is reasonable (class 2a) for patients with a CHA2DS2-VASc score of 2 or more who have a medical reason not to take long-term anticoagulation, and might reasonably replace anticoagulation (class 2b) when stroke risk is moderate to high and bleeding risk on anticoagulants is high.",
        "branch_condition": "CHA2DS2-VASc score of 2 or more with a medical reason not to take anticoagulants long term; or moderate to high stroke risk with a high chance of serious bleeding on them",
        "claims": [
          "cardio:claim-acc-aha-2023-af-laao"
        ]
      }
    ]
  },
  "content_digest": "1798c0318dc45240f491acdc6deb6b2fa6249476434f01871f02e537319a8191",
  "review": {
    "content_digest": "1798c0318dc45240f491acdc6deb6b2fa6249476434f01871f02e537319a8191",
    "current": [],
    "conflicting": [],
    "stale": [],
    "inactive": []
  },
  "claims": [],
  "decisions": [],
  "milestones": [],
  "relationships": {
    "outgoing": [
      {
        "predicate": "related_to",
        "label": "The condition this pathway addresses",
        "clinical_claim_not_fact": false,
        "family": "navigation",
        "other_entity_id": "cardio:atrial-fibrillation",
        "other_entity_in_atlas": true,
        "claim_id": null,
        "evidence": null,
        "primary": false,
        "role": null,
        "valid_from": null,
        "valid_to": null
      }
    ],
    "incoming": []
  },
  "page_path": "care-pathways/pathway-af-stroke-prevention/",
  "context_path": "api/v1/context/cardio--pathway-af-stroke-prevention.md"
}