Patients with AF NA NA Patient preferences Factors which affect patient preferences Quality of life RCTs Observational studies ACS acute coronary syndrome; AF atrial brillation; DCA decision curve analysis; ICH intracranial hemorrhage; IDI integrated discrimination index; INR international normalized ratio; LMWH low- molecular-weight heparin; MI myocardial infarction; NA not available; NOAC non-vitamin K antagonist oral anticoagulant drug; NRI net reclassi cation index; OAC oral anticoagulant; RCT randomized controlled trial; SR systematic reviews; TE thromboembolism; TEE transesophageal echocardiography; TTR time within therapeutic range; VKA vitamine K antagonist. chestjournal.org TABLE 2 ] CHEST Grading System Grade of Recommendation Bene t vs Risk and Burdens Methodologic Strength of Supporting Evidence Implications Strong recommendation, High quality evidence Bene ts clearly outweigh risk and burdens, or vice versa We are very con dent that the true effect lies close to that of the estimate of the effect Recommendation can apply to most patients in most circumstances. Further research is very unlikely to change our con dence in the estimate of effect Strong recommendation, Moderate-quality evidence Bene ts clearly outweigh risk and burdens, or vice versa We are moderately con dent in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Recommendation can apply to most patients in most circumstances. Higher quality research may well have an important impact on our con dence in the estimate of effect and may change the estimate Strong recommendation, Low quality evidence Bene ts clearly outweigh risk and burdens, or vice versa Our con dence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Recommendation can apply to most patients in many circumstances. 