Rating of the quality of evidence was low to moderate, and the ndings should be interpreted accordingly. The advantages of self-monitoring and self-management include convenience and freedom for the patient, patient empowerment/control over their condition and treatment, increased patient satisfaction, all of which may improve quality of life. However, this approach may not be a viable option for all patients requiring VKA therapy as it is initially expensive, requires mastery of the point-of-care device, and for those self-managing, the knowledge and ability to dose-adjust, plus the appropriate health-care system infrastructure and patient support which may not be feasible globally. For many AF patients, an NOAC might be a more suitable alternative. Practical Patient Management Algorithm The approach to stroke prevention in patients with AF can be simpli ed into a simple 3-step algorithm (Fig 4). The initial step is to determine the risk of stroke. As noted in the Stroke Risk in AF section, risk scores for stroke in patients with AF lack speci city, and are therefore not Acronym Risk Factors Points S Sex (female) 1 A Age (< 60 y) 1 Me Medical history ($ 2 from: hypertension, diabetes mellitus, coronary artery disease/myocardial infarction, peripheral arterial disease, congestive heart failure, previous stroke, pulmonary disease, and hepatic or renal disease) T Treatment (interacting drugs [eg, amiodarone]) 1 T Tobacco use (within 2 y) 2 R Race (non-white) 2 Maximum score 8 1158 Evidence-Based Medicine [ 1 5 4 # 5 C H E S T N O V E M B E R 2 0 1 8 ] clinically useful in identifying and categorizing high-risk patients. 