Pharmacological Management Of Newly Detected Atrial Fibrillation

Publication Date: April 1, 2017

Treatment

Rate control is preferred over rhythm control for the majority of patients who have atrial fibrillation. ( S , M )
565
Preferred options for rate-control therapy include non-dihydropyridine calcium channel blockers and beta blockers. Rhythm control may be considered for certain patients based on patient symptoms, exercise tolerance, and patient preferences. ( W , L )
565
Lenient rate control (<110 beats per minute resting) is preferred over strict rate control (<80 beats per minute resting) for patients who have atrial fibrillation. ( W , L )
565
Clinicians should discuss the risk of stroke and bleeding with all patients considering anticoagulation. ( GP , )
565
Clinicians should consider using the continuous CHADS2 or continuous CHA2DS2-VASc for prediction of risk of stroke ( W , L )
565
and HAS-BLED for prediction of risk for bleeding. (, )
565
in patients who have atrial fibrillation.
Clinicians should discuss the risk of stroke and bleeding with all patients considering anticoagulation ( GP , )
565
Clinicians should consider using the continuous CHADS2 or continuous CHA2DS2-VASc for prediction of risk of stroke. (, )
565
and HAS-BLED for prediction of risk for bleeding in patients who have atrial fibrillation. (, )
565
Patients who have atrial fibrillation should receive chronic anticoagulation unless they are at low risk of stroke (CHADS2 <2)or have specific contraindications ( S , H )
Choice of anticoagulation therapy should be based on patient preferences and patient history. Options for anticoagulation therapy may include warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban.
565
Dual treatment with anticoagulant and antiplatelet therapy is NOT recommended for most patients who have atrial fibrillation. ( S , M )
565

Recommendation Grading

Disclaimer

Overview

Title

Pharmacological Management Of Newly Detected Atrial Fibrillation

Authoring Organization

Publication Month/Year

April 1, 2017

Document Type

Guideline

External Publication Status

Published

Country of Publication

US

Document Objectives

The purpose of this guideline is to provide recommendations for primary care-relevant pharmacologic treatments of patients who have nonvalvular atrial fibrillation. While other treatments were deemed outside the scope of this guideline, family physicians should be aware of the full range of options and discuss these with their patients. The target audience is family physicians and other primary care clinicians. The target patient population is adults who have atrial fibrillation, as defined by electrocardiographic evidence of atrial fibrillation with or without symptoms. All frequencies and durations of atrial fibrillation (paroxysmal, persistent, and permanent) are included.

Target Patient Population

Adults who have nonvalvular atrial fibrillation that is not due to a reversible cause

Target Provider Population

Family Physicians and other primary care clinicians

Inclusion Criteria

Male, Female, Adult, Older adult

Health Care Settings

Ambulatory, Outpatient

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Treatment, Management

Diseases/Conditions (MeSH)

D001281 - Atrial Fibrillation

Keywords

atrial fibrillation, antiarrhythmic drug therapy, nonvalvular atrial fibrillation, afib

Methodology

Number of Source Documents
33
Literature Search Start Date
January 1, 2000
Literature Search End Date
December 31, 2015