This is the updated guideline from NICE on atrial fibrillation. This guideline is very different overall to the last guideline, but it probably doesn’t contain anything radical if you’ve been to any AF teaching in the last couple of years.
As this is such a common problem, I’ve summarised the whole thing, mainly in the format of algorithms to follow, so hopefully these will be easy to refer to if needed.
Who is covered in this guideline?
- Atrial Fibrillation
- Persistent (it has lasted more than 7 days, but is likely to be amenable to cardioversion treatment)
- Permanent (where cardioversion has either not been tried, or has been tried and was unsuccessful).
- Atrial Flutter
- Anyone with an ongoing risk of arrhythmia after cardioversion
What should be the initial management of AF?
How do I calculate the CHA2DS2-Vasc Score?
How do I calculate the Hasbled Score?
Should you rate or rhythm control?
Drug treatment without cardioversion
- AF not controlled by 1st line drugs
- After other options have been considered
- Have at least 1 of the following risk factors:
- Hypertension needing drugs of at least 2 different classes
- Diabetes Mellitus
- Previous TIA / stroke / systemic thromboembolism
- LA diameter ≥ 50mm
- Age 70 or over
- Where have infrequent paroxysms and few symptoms
- Known precipitants (eg alcohol / caffeine)
- Can understand when and how to use
- If they have
- No history of left ventricular dysfunction/valvular/IHD
- Systolic BP > 100 AND
- Resting heart rate > 70
What kind of anticoagulation should I use and what needs to be considered?
- Explain to patients that generally the benefits of anticoagulation outweigh the risks.
- Do not offer anticoagulation to people under the age of 65, whose sole risk is their sex.
- Do not withhold anticoagulation just because someone is at risk of falls.