Management of atrial fibrillation pdf content on this site is NICE copyright unless otherwise stated. You can download material for private research, study or in-house use only.
Do not distribute or publish any material from this site without first obtaining NICE’s permission. This guideline covers diagnosing and managing atrial fibrillation in adults. It aims to ensure that people receive the best management to help prevent harmful complications, in particular stroke and bleeding. In August 2014, recommendation 1.
2 was clarified to refer to people without life-threatening haemodynamic instability. Is this guideline up to date? The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian. Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it.
They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties. This site has been blocked by the network administrator. The primary factors determining AF treatment are duration and evidence of circulatory instability. Most patients with AF are at increased risk of stroke. 4 in men and 3. AF concluded that a prior history of stroke or TIA is the most powerful risk factor for future stroke, followed by advancing age, hypertension, and diabetes.
For patients with LAF, the risk of stroke is very low and is independent of whether the LAF was an isolated episode, paroxysmal, persistent, or permanent. Finally, patients under 65 are much less likely to develop embolization compared with patients over 75. The c-statistics at 10 years follow-up were 0. To compensate for the increased risk of stroke, anticoagulants may be required. 3 indicates “high risk” and some caution and regular review of the patient is needed. 7329 patients with AF – in this study, the HAS-BLED score offered some improvement in predictive capability for bleeding risk over previously published bleeding risk assessment schemas and was simpler to apply. AF in the context of mitral stenosis is associated with a seventeenfold increase in stroke risk.
Conference on Antithrombotic and Thrombolytic Therapy recommends initiating warfarin without heparin bridging. In AF, the usual target INR is between 2. A high INR may indicate increased bleeding risk, while a low INR would indicate that there is insufficient protection from stroke. An attempt was made to find a better method of implementing warfarin therapy without the inconvenience of regular monitoring and risk of intracranial hemorrhage. INR monitoring, while offering similar results in terms of efficacy in the treatment of non-valvular AF.
The place of the new thrombin inhibitor class of drugs in the treatment of chronic AF is still being worked out. Patients aged 80 years or more may be especially susceptible to bleeding complications, with a rate of 13 bleeds per 100 person-years. Of note, this study had very low rate of hemorrhagic complications in the warfarin group. A trial comparing closure against warfarin therapy found closure to be non-inferior when measured against a composite end point of stroke, cardiovascular death and systemic embolism. AF can cause disabling and annoying symptoms.