Pharmacological Management Of Newly Detected Atrial Fibrillation
Publication Date: April 1, 2017
Key Points
Key Points
- Atrial fibrillation (AF) is one of the most common types of arrhythmia in adults worldwide, with an estimated 2.7–6.1 million people affected in the United States.
- Because AF is more common in adults >65 years of age, this figure will continue to rise as the population ages.
- AF presents as a change in heart rate with an irregular pattern, with symptoms that may worsen/change over time.
- AF can occur as episodes (paroxysmal) or continuously (persistent).
- Symptom presentation can vary among patients, with some being asymptomatic and others complaining of irregular heart rate, heart palpitations, lightheadedness, extreme fatigue, shortness of breath, anxiety, and chest pain.
- In addition to an increase in mortality, myocardial infarction, heart failure exacerbation and cardiomyopathy, patients who have AF have a significantly increased risk of stroke.
- Almost a quarter of all strokes in the elderly are related to AF.
- Management options for AF involve rate control, rhythm control, and prevention of thromboembolic events.
- Options include medications to slow the heart rate, medications to achieve and maintain a regular rhythm, electrical cardioversion, ablation, and other surgical interventions.
- Stroke prophylaxis is a mainstay of management for individuals with AF who have additional risk factors for stroke.
- Stroke risk can be predicted using the continuous CHADS2 or continuous CHA2DS2-VASc risk assessment scores (See Tables 1–3).
- Bleeding risk can also be assessed for patients treated with anticoagulants or aspirin. The HAS-BLED scale (Hypertension, Abnormal renal/liver function, Stroke, Bleeding history or predisposition, Labile international normalized ratio, Elderly (>65 years), Drugs/alcohol concomitantly) is the most studied and most commonly used.
- Many of the risk factors for bleeding are the same as those for stroke, making it challenging to estimate the trade-off between stroke risk and
risk of bleeding.
Treatment
Treatment
...ol is preferred over rhythm contro...
...ferred options for rate-control ther...
Lenient rate cont...
...ould discuss the risk of stroke and bleeding w...
...ld consider using the continuous CHADS2 or con...
...ED for prediction of risk for bleeding. (, )565...
...should discuss the risk of stroke and bleeding wi...
...uld consider using the continuous CHA...
...r prediction of risk for bleeding in patients...
Patients who have atrial fibrillation...
...al treatment with anticoagulant and...
... Risk Assessment ScoreHaving trouble...
Table 2. CHA2DS2-VASc Risk Assessment Sco...
...3. Treatment Based on CHADS2Â ScoreHaving tr...
...al Anticoagulants for Stroke Prevention in...
...ased Risk of Major Bleeding with Dual...