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...
...ate control is preferred over rhythm...
...options for rate-control therapy includ...
Lenient rate control (
...ians should discuss the risk of stroke a...
...ns should consider using the continuous...
...-BLED for prediction of risk for bl...
...linicians should discuss the risk of stroke and...
...ans should consider using the continuous CHADS2...
and HAS-BLED for prediction of ris...
...have atrial fibrillation should receive...
...nt with anticoagulant and antiplatelet t...
Table 1. CHADS2 Risk Assessment ScoreHaving t...
...able 2. CHA2DS2-VASc Risk Assessment S...
...atment Based on CHADS2 ScoreHaving trouble view...
...al Anticoagulants for Stroke Prevention in Patie...
...Increased Risk of Major Bleeding with Dual T...