Deepthy Varghese, MSN, ACNP, FNP, Northside Hospital, is joined by Gregory Lip, MD., University of Liverpool, and Elaine Y. Wan, MD, FHRS Columbia University, Cardiology to discuss the limitations of current clinical decision tools for assessing bleeding risk in individuals with atrial fibrillation (AF) taking direct-acting oral anticoagulants (DOACs). Conducted as a secondary analysis of the RE-LY trial and validated in multiple cohorts, the study introduces the DOAC Score as a personalized risk assessment tool. The DOAC Score incorporates various covariates such as age, creatinine clearance, underweight status, medical history, and medication use to estimate the comparative risk for major bleeding. The risk prediction model demonstrated robust performance, outperforming the HAS-BLED score in terms of predictive accuracy. Internal and external validation in diverse cohorts, including the GARFIELD-AF registry, COMBINE-AF pooled clinical trial cohort, and administrative databases, confirmed the score's reliability in stratifying bleeding risk among individuals on different DOACs. The DOAC Score represents a significant advancement in tailoring risk assessments for bleeding in AF patients receiving DOAC therapy, contributing to more informed clinical decision-making. 

• Understand the Limitations of Current Bleeding Risk Assessment Tools
• Explore the Components of the DOAC Score in Detail 

ACE Disclosure Policy

The Heart Rhythm Society is committed to the provision of Accredited Continuing Education (formerly known as Continuing Medical Education (CME)) that is balanced, objective, and evidence based. HRS adheres to the Standards for Integrity and Independence in Accredited Continuing Education of the Accreditation Council for Continuing Medical Education (ACCME) which require that those individuals in a position to control the content of an educational activity (including, but not limited to, planners, faculty, authors, committee members, content reviewers, editors, and staff) disclose all financial relationships with an ACCME-defined ineligible company* within the 24 months prior to the disclosure.

Any individual who refuses to disclose financial relationships is disqualified from participating in HRS ACE-certified activities. Owners and employees of ACCME-defined ineligible companies may have no role in the planning or implementation of ACE activities without a special written exemption from the HRS Chief Learning Officer that will be granted only in specific circumstances that meet ACCME requirements.

ACCME Definition:

*An ineligible company is one whose primary business is producing, marketing, selling, re-selling, or distributing healthcare products used by or on patients.

Examples of such organizations include:

• Advertising, marketing, or communication firms whose clients are ineligible companies
• Bio-medical startups that have begun a governmental regulatory approval process
• Compounding pharmacies that manufacture proprietary compounds
• Device manufacturers or distributors
• Diagnostic labs that sell proprietary products
• Growers, distributors, manufacturers or sellers of medical foods and dietary supplements
• Manufacturers of health-related wearable products
• Pharmaceutical companies or distributors
• Pharmacy benefit managers
• Reagent manufacturers or sellers

G. Lip: Honoraria, Speaking, and Consulting: Bristol-Myers Squibb, Pfizer, Inc., Daiichi 
E. Wan: Honoraria, Speaking, and Consulting: Medtronic, National Institutes for Health, Sanofi, Boston Scientific, Research: Zoll Medical Corp. 

Accreditation Statement
The Heart Rhythm Society is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.

Physicians AMA Designation Statement
The Heart Rhythm Society designates this internet-enduring activity for a maximum of .25 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

ABIM Maintenance of Certification (MOC) Statement 

Successful completion of this ACE activity, which includes participation in the evaluation component, enables the participant to earn up to .25 MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of ACE credits claimed for the activity. It is the ACE activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

Royal College of Physicians and Surgeons of Canada MOC Recognition Statement
Through an agreement between the Accreditation Council for Continuing Medical Education and the Royal College of Physicians and Surgeons of Canada, medical practitioners participating in the Royal College MOC Program may record completion of accredited activities registered under the ACCME’s “ACE in Support of MOC” program in Section 3 of the Royal College’s MOC Program.

Other Credit Available
A Credit Certificate (for physicians) or Certificate of Participation (for non-physicians) will be provided to individuals seeking credit from the following organizations which accept AMA PRA Category 1 Credit(s)™. Note that participants are advised to contact their certifying body for specific information regarding credit submissions:
·         American Academy of Family Physicians (AAFP) (for elective credit)
·         American Academy of Nurse Practitioners Certification Board (AANPCB)
·         American Academy of Physician Assistants (AAPA)
·         American Nurses Credentialing Center (ANCC)
·         American Osteopathic Association (AOA) (for Category 2 credit)
·         Committee on Accreditation of Continuing Medical Education (Canada)
·         European Board for Accreditation in Cardiology (EBAC)
·         European CME Credits (ECMEC)
·         German Chambers of Physicians
·         National Society of Genetic Counselors (for Category 2 credit)
·         Oman Medical Specialty Board
·         Qatar Council for Healthcare Practitioners
·         Royal College of Physicians and Surgeons of Canada (RCPSC)