[2021] For a short explanation of why the committee made the 2021 recommendations and how they might affect practice, see the rationale and impact section on detection and diagnosis. Full details of the evidence and the committee's discussion are in evidence review A: effectiveness of tests for detection and evidence review B: accuracy of tests for detection. 1.2 Assessment of stroke and bleeding risks Stroke risk 1.2.1 Use the CHA2DS2-VASc stroke risk score to assess stroke risk in people with any of the following: symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation atrial flutter a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm or catheter ablation. [2021] See the section on review of people with atrial fibrillation for advice on reassessment of stroke risk. For a short explanation of why the committee made this recommendation and how it might affect practice, see the rationale and impact section on stroke risk. Full details of the evidence and the committee's discussion are in evidence review C and D: tools to predict stroke in people with atrial fibrillation. Bleeding risk 1.2.2 Assess the risk of bleeding when: considering starting anticoagulation in people with atrial fibrillation and reviewing people already taking anticoagulation. Use the ORBIT bleeding risk score because evidence shows that it has a higher accuracy in predicting absolute bleeding risk than other bleeding risk tools. Accurate knowledge of bleeding risk supports shared decision making and has practical benefits, for example, increasing patient confidence and willingness to accept treatment when risk is low and prompting discussion of risk reduction when risk is high. Although ORBIT is the best tool for this purpose, other bleeding risk tools may need to be used until it is embedded in clinical pathways and electronic systems. 