New guide for big heart risk
Experts have developed Australia’s first guidelines for the diagnosis and management of atrial fibrillation (AF).
AF is an increasingly prevalent heart arrythmia which heightens the risk of stroke.
International guidelines on AF do exist, but according to the authors of the new recommendations, “individual recommendations may differ, and no guidelines have previously been developed specific to the Australian population”.
A large group of clinicians led by the National Heart Foundation of Australia (NHF) and the Cardiac Society of Australia and New Zealand (CSANZ) developed the guidelines “to assist Australian clinicians in the diagnosis and management of adult patients with AF”, using “recent evidence interpreted by local experts to optimise application in an Australian context”.
Changes in management as a result of the guidelines include:
Opportunistic screening in the clinic or community is recommended for patients over 65 years of age
The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is emphasised; beta-blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control; cardioversion remains the first line choice for acute rhythm control when clinically indicated; flecainide is preferable to amiodarone for acute and chronic rhythm control; failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation
The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2; if anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin
An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available; regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur
Guidelines for the prevention, detection and management of heart failure (HF) have been updated too, and are accessible here.