The AAFP has released a new clinical practice guideline to help clinicians in the pharmacologic management of atrial fibrillation, according to the Academy’s website.
“While other treatments were deemed outside the scope of this guideline, family physicians should be aware of the full range of options and discuss these with their patients,” an AAFP press release stated. “This guideline does not apply to patients who have atrial fibrillation due to a reversible cause (postoperative, postmyocardial infarction, or due to hyperthyroidism) or patients who have atrial fibrillation due to valvular disease.”
Some of the recommendations include:
•recommending rate control in preference to rhythm control for most patients with atrial fibrillation: The preferred options for rate control therapy include nondihydropyridine calcium channel blockers and beta blockers;
•considering rhythm control for certain patients based on patient symptoms, exercise tolerance, and patient preferences;
•recommending lenient rate control (fewer than 110 beats/minute resting) over strict rate control (fewer than 80 beats/minute resting) for patients with atrial fibrillation;
•discussing the risk for stroke and bleeding with all patients considering anticoagulation: The continuous CHADS2 or continuous CHA2DS2-VASc should be considered for prediction of risk for stroke, and the HAS-BLED should be considered for prediction of risk for bleeding in patients with atrial fibrillation;
•recommending chronic anticoagulation for patients with atrial fibrillation unless they are at low risk for stroke (CHADS2 of less than 2) or have specific contraindications: Choice of anticoagulation therapy should be based on patient preferences and patient history and may include apixaban, dabigatran, edoxaban, rivaroxaban or warfarin; and
•not recommending dual treatment with anticoagulant and antiplatelet therapy in most patients with atrial fibrillation.
Other changes in the new guideline entail adding a consumer/patient representative; including evidence for new direct oral anticoagulants and evidence on strict vs. lenient rate control; narrowing the scope of the guideline to focus solely on pharmacologic management; and adding a recommendation on risk assessment for stroke, and shared decision-making tools to compare treatment options for rate control and anticoagulation.
The AAFP stated that this guideline updates and replaces an earlier guideline published in 2003 from the Academy and the ACP, which was reaffirmed by the AAFP in 2008
According to the release, atrial fibrillation increases a person’s risk for stroke by four to five times compared to those who don’t have the arrhythmia disorder. The Academy also stated that atrial fibrillation currently affects up to 6.1 million people, but the number of patients is expected to increase in the future.
Pharmacologic Management of Newly Detected Atrial Fibrillation
(accessed from AAFP’s website 06-01-2017)