Afib guideline updates diagnosis, management strategies
An updated guideline from cardiology societies places new emphasis on lifestyle and risk factor modification in patients with atrial fibrillation and risk for recurrence when afib occurs after surgery, among other changes.
A group of cardiology societies have updated their guidelines on atrial fibrillation (AF).
The 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation, from the American College of Cardiology, the American Heart Association, the American College of Chest Physicians, and the Heart Rhythm Society, provides recommendations to guide clinicians in the treatment of AF. The guideline was published by Circulation and the Journal of the American College of Cardiology on Nov. 30.
Among the top updates outlined in the guideline are the following:
- The previous classification of AF was based only on arrhythmia duration and emphasized therapeutic interventions. The new proposed classification uses stages on a disease continuum that requires varied strategies at each stage, such as prevention, lifestyle and risk factor modification, screening, and therapy.
- The guideline newly recognizes lifestyle and risk factor modification as a pillar of AF management to prevent onset, progression, and adverse outcomes.
- Recommendations for anticoagulation are now made based on yearly thromboembolic event risk using a validated clinical risk score, such as CHA2DS2-VASc, but also offer flexibility, such that patients at intermediate risk who remain uncertain about the benefit of anticoagulation can consider other risk variables to help inform their decisions.
- Clinicians should consider stroke risk modifiers in patients at intermediate to low annual risk to inform shared decision-making.
- The guideline emphasizes the importance of early and continued management of patients with AF, focusing on maintaining sinus rhythm and minimizing disease burden.
- The guideline upgraded its recommendation for catheter ablation, noting that it is superior to drug therapy for rhythm control in appropriately selected patients, including those with heart failure and reduced ejection fraction.
- More prescriptive recommendations are provided for patients with device-detected AF, considering the interaction between episode duration and underlying risk for thromboembolism.
- For left atrial appendage occlusion devices, the class of recommendation has been upgraded.
- Recommendations on AF identified during noncardiac illness or surgery place new emphasis on the risk of recurrence.
The guideline concludes by highlighting gaps in current research on AF.