Management and clinical outcome of patients with atrial fibrillation stratified by the 4S-AF scheme for structured characterization of atrial fibrillation: data from CODE-AF registry

Abstract Background Recently, 4S-AF scheme consisting of four essential domains requiring for integrated management of atrial fibrillation (AF), including stroke prevention, symptom severity, severity of AF burden, and substrate for AF, has been proposed for the structured characterization of AF. Purpose To classify patients with AF applying 4S-AF scheme, evaluate how rhythm control and stroke prevention strategies were applied according to the 4S-AF scheme, and analyze the association between 4S-AF scheme score and the risk of clinical outcome, composite of stroke and admission for heart failure in patients with AF. Methods Using the data from the COmparison study of Drugs for symptom control and complication prEvention of Atrial Fibrillation (CODE-AF) registry from June 2015 to October 2020, we identified patients with AF who had information about 4S. The 4S-AF scheme score was calculated by stroke risk (truly low risk patients = 0; otherwise = 1), symptom severity (no symptom = 1; presence of symptom = 1), severity of AF burden (paroxysmal = 0, persistent = 1, and long-persistent to permanent = 2), substrate for AF (add 1 if >75 years; no comorbidity=1, 1 comorbidity = 1, 2 or more comorbidities = 2; left atrial anteroposterior diameter