Psoriasis and atrial fibrillation: Exploring the intersection

Table 1 Recommendations for monitoring and managing atrial fibrillation risk in psoriasis patients

Risk tier	Category	Recommendation	Evidence level
All patients	Integrated care approach	Multidisciplinary collaboration between dermatologists, cardiologists, and primary care providers	Class C3
Low risk (e.g., mild psoriasis, no comorbidities)	Inflammation control and lifestyle	Lifestyle modification (weight loss, smoking cessation, physical activity)	Class B2
	Cardiovascular screening	Routine evaluation of BP, lipids, glucose	Class A1
	Cardiovascular screening	Baseline ECG and risk factor review	Class B2
Moderate risk (e.g., moderate psoriasis, single comorbidity)	Risk stratification	Assess and manage comorbid obesity, diabetes, depression, hypertension	Class A1
	Cardiovascular screening	Periodic ECG focusing on P-wave dispersion and conduction delays	Class B2
	Inflammation control and lifestyle	Systemic anti-inflammatory strategies targeting adipose tissue inflammation	Class C3
High risk (e.g., severe psoriasis, ≥ 2 comorbidities, prior stroke/AF)	Risk stratification	Consider severe psoriasis (high PASI score) as high AF risk	Class B2
	Risk stratification	Use biomarkers like RDW and MPV to flag elevated CV risk	Class C3
	Stroke prevention	Early echocardiography (LA strain, fibrosis, pulmonary pressure)	Class B2
	Stroke prevention	Lower threshold for initiating anticoagulation (e.g., modified CHA2DS2-VASc)	Class B2
	Biologic therapies	Weigh AF risk in selecting biologics (e.g., IL-17, IL-23 vs TNFi)	Class C3
	Biologic therapies	Closely monitor patients starting biologics with reported AF signals in pharmacovigilance data (e.g., risankizumab, ixekizumab)	Class C3

¹Class A: Strong evidence from randomized controlled trials or meta-analyses.

²Class B: Moderate evidence from observational or non-randomized studies.

³Class C: Expert opinion or clinical rationale.

AF: Atrial fibrillation; BP: Blood pressure; CRP: C-reactive protein; IL: Interleukin; MPV: Mean platelet volume; PASI: Psoriasis Area and Severity Index; RDW: Red cell distribution width; TNFi: Tumor necrosis factor inhibitor; CV: Cardiovascular; LA: Left atrial.