Rivera-Caravaca, José Miguel (57126396500)José Miguel (57126396500)Rivera-CaravacaPiot, Olivier (7006174412)Olivier (7006174412)PiotRoldán-Rabadán, Inmaculada (7801463733)Inmaculada (7801463733)Roldán-RabadánDenis, Arnaud (55220017900)Arnaud (55220017900)DenisAnguita, Manuel (7006173532)Manuel (7006173532)AnguitaMansourati, Jacques (55847760200)Jacques (55847760200)MansouratiPérez-Cabeza, Alejandro (16639169700)Alejandro (16639169700)Pérez-CabezaMarijon, Eloi (12143483700)Eloi (12143483700)MarijonGarcía-Seara, Javier (6508344902)Javier (6508344902)García-SearaLeclercq, Christophe (7006426549)Christophe (7006426549)LeclercqGarcía-Bolao, Ignacio (58403332700)Ignacio (58403332700)García-BolaoLellouche, Nicolas (6602763709)Nicolas (6602763709)LellouchePotpara, Tatjana (57216792589)Tatjana (57216792589)PotparaBoriani, Giuseppe (57675336900)Giuseppe (57675336900)BorianiFauchier, Laurent (7005282545)Laurent (7005282545)FauchierLip, Gregory Y.H. (57216675273)Gregory Y.H. (57216675273)LipMarín, Francisco (57212539524)Francisco (57212539524)Marín2025-06-122025-06-122022https://doi.org/10.1093/europace/euab202https://www.scopus.com/inward/record.uri?eid=2-s2.0-85120411274&doi=10.1093%2feuropace%2feuab202&partnerID=40&md5=9af416e9c68e67b5845898942d088c29https://remedy.med.bg.ac.rs/handle/123456789/3726Aims: The 4S-AF scheme [Stroke risk, Symptom severity, Severity of atrial fibrillation (AF) burden, Substrate severity] has recently been described as a novel approach to in-depth characterization of AF. We aim to determine if the 4S-AF scheme would be useful for AF characterization and provides prognostic information in real-world AF patients. Methods and results: The Spanish and French cohorts of the EORP-AF Long-Term General Registry were included. The baseline 4S-AF scheme was calculated and related to the primary management strategy (rhythm or rate control). Follow-up was performed at 1-year with all-cause mortality and the composite of ischaemic stroke/transient ischaemic attack/systemic embolism, major bleeding, and all-cause death, as primary endpoints. A total of 1479 patients [36.9% females, median age 72 interquartile range (IQR 64-80) years] were included. The median 4S-AF scheme score was 5 (IQR 4-7). The 4S-AF scheme, as continuous and as categorical, was associated with the management strategy decided for the patient (both P < 0.001). The predictive performances of the 4S-AF scheme for the actual management strategy were appropriate in its continuous [c-index 0.77, 95% confidence interval (CI) 0.75-0.80] and categorical (c-index 0.75, 95% CI 0.72-0.78) forms. Cox regression analyses showed that 'red category' classified patients in the 4S-AF scheme had a higher risk of all-cause death (aHR 1.75, 95% CI 1.02-2.99) and composite outcomes (aHR 1.60, 95% CI 1.05-2.44). Conclusion: Characterization of AF by using the 4S-AF scheme may aid in identifying AF patients that would be managed by rhythm or rate control and could also help in identifying high-risk AF patients for worse clinical outcomes in a 'real-world' setting. © 2021 Published on behalf of the European Society of Cardiology. All rights reserved.4S-AFAtrial fibrillationCharacterizationClassification schemeEORP-AF registryMortalityReal-world registryRisk assessment