Background: Atrial fibrillation (AF) is a common cardiac arrhythmia that increases the risk of stroke. Medical therapy for decreasing stroke risk involves anticoagulation, which may increase bleeding risk for certain patients. In determining optimal therapy for stroke prevention for patients with AF, clinicians use tools with various clinical, imaging, and patient characteristics to weigh stroke risk against therapy-associated bleeding risk. Aim: Review published literature and summarize available risk stratification tools for stroke and bleeding prediction in patients with AF. Methods: We searched for English-language studies in PubMed®, Embase®, and the Cochrane Database of Systematic Reviews published between January 1, 2000, and February 14, 2018. Two reviewers screened citations for studies that examined tools for predicting thromboembolic and bleeding risks in patients with AF. Data regarding study design, patient characteristics, interventions, outcomes, quality and applicability were extracted. Results: 61 studies were relevant to predicting thromboembolic risk and 38 to predicting bleeding risk. Data suggest that CHADS2, CHA2DS2-VASc, and ABC risk scores have the best evidence predicting thromboembolic risk (moderate strength of evidence for limited prediction ability of each score) and that HAS-BLED has the best evidence for predicting bleeding risk (moderate strength of evidence). Limitations: Studies were heterogeneous in methodology and populations of interest, setting, interventions, and outcomes analyzed. Conclusion: CHADS2, CHA2DS2-VASc, and ABC stroke have the best prediction for stroke events, and HAS-BLED provides the best prediction for bleeding risk. Future studies should define the role of imaging tools and biomarkers in enhancing the accuracy of risk prediction tools. Primary Funding Source: Patient-Centered Outcomes Research Institute (PROSPERO #CRD42017069999)

BACKGROUND: Telehealth employs technology to connect patients to the right healthcare resources at the right time. Women are high utilizers of healthcare with genderspecific health issues that may benefit from the convenience and personalization of telehealth. Thus, we produced an evidence map describing the quantity, distribution, and characteristics of evidence assessing the effectiveness of telehealth services designed for women. METHODS: We searched MEDLINE ® (via PubMed ® ) and Embase ® from inception through March 20, 2018. We screened systematic reviews (SRs), randomized trials, and quasi-experimental studies using predetermined eligibility criteria. Articles meeting inclusion criteria were identified for data abstraction. To assess emerging trends, we also conducted a targeted search of ClinicalTrials.gov. RESULTS: Two hundred thirty-four primary studies and three SRs were eligible for abstraction. We grouped studies into focused areas of research: maternal health (n = 96), prevention (n = 46), disease management (n = 63), family planning (n = 9), high-risk breast cancer assessment (n = 10), intimate partner violence (n = 7), and mental health (n = 3). Most interventions focused on phone as the primary telehealth modality and featured healthcare team-to-patient communication and were limited in duration (e.g., < 12 weeks). Few interventions were conducted with older women (≥ 60 years) or in racially/ ethnically diverse populations. There are few SRs in this area and limited evidence regarding newer telehealth modalities such as mobile-based applications or short message service/texting. Targeted search of clinical.trials.gov yielded 73 ongoing studies that show a shift in the use of non-telephone modalities. DISCUSSION: Our systematic evidence map highlights gaps in the existing literature, such as a lack of studies in key women's health areas (intimate partner violence, mental health), and a dearth of relevant SRs. With few existing SRs in this literature, there is an opportunity for examining effects, efficiency, and acceptability across studies to inform efforts at implementing telehealth for women.

Agency for Healthcare Research and Quality (PROSPERO: CRD42016047032).

Background: The comparative safety and effectiveness of treatments to prevent thromboembolic complications in atrial fibrillation (AF) remains uncertain. Purpose: To compare the available treatment strategies in patients with AF. Data Sources: English-language studies in multiple databases from January 1, 2000, to February 14, 2018. Study Selection: Two reviewers independently screened citations for studies examining treatments for stroke prevention in patients with AF. Data Extraction: Two reviewers independently abstracted data and assessed study quality and applicability. Data Synthesis: Data from 220 articles were included. Dabigatran and apixaban were superior while rivaroxaban and edoxaban were similar to warfarin in the prevention of stroke or systemic embolism. Apixaban and edoxaban were superior while rivaroxaban and dabigatran were similar to warfarin in reducing the risk of major bleeding. Treatment effects with dabigatran were similar in patients with renal dysfunction (interaction p>0.05) and patients less than 75 years old had lower rates of bleeding with dabigatran (interaction p<0.001). The benefit of treatment with apixaban was consistent in many subgroups including those with renal impairment, diabetes and prior stroke (interaction p>0.05 for all). The greatest bleeding risk reduction was observed in patients with GFR<50mL/min (p=0.003). Similar treatment effects of rivaroxaban and edoxaban were observed in patients with prior stroke, diabetes, or heart failure (interaction p>0.05 for all). Limitations: Heterogeneous study populations, interventions and outcomes. Conclusion: The available DOACs are at least as effective and safe when compared to warfarin. Similar benefits of treatment with DOACs were observed across multiple patient subgroups of interest, giving assurance to the safe and efficacious use of DOACs for a wide range of patients with AF. Primary Funding Source: Patient-Centered Outcomes Research Institute (PROSPERO #CRD42017069999)