This is an updated guideline from NICE on Atrial Fibrillation. It was published in April 2021. The last major update was in 2014.
I am going to outline the new major changes in this update, then do a general overview of management.
So what is new in this guideline?
There are two important new changes in this guideline.
- Assessing bleeding risk. We should now use the ORBIT bleeding risk score, instead of the HASBLED score. https://www.mdcalc.com/orbit-bleeding-risk-score-atrial-fibrillation This change has been made because the ORBIT score seems to predict bleeding risk better than the HASBLED score. It is however important to note that ORBIT doesn’t consider reversible causes of bleeding risk like HASBLED does. We will therefore need to proactively think about these as they will need addressing. I have discussed this further below.
- Warfarin is now second line. We should be offering a DOAC as first line treatment. They are more effective than warfarin and have a better balance of costs to benefits.If a patient is well established and controlled on warfarin, then they can remain on it if they want.
What conditions are covered by this guideline?
- AF, whether symptomatic or asymptomatic and whether permanent, paroxysmal or persistent.
- Atrial flutter.
- Patients at risk of a recurrence of arrhythmia after cardioversion or catheter ablation.