Pharmacological Management Of Newly Detected Atrial Fibrillation
Publication Date: April 1, 2017
Last Updated: December 16, 2022
Treatment
Rate control is preferred over rhythm control for the majority of patients who have atrial fibrillation. ( S , M )
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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 )
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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 )
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Clinicians should discuss the risk of stroke and bleeding with all patients considering anticoagulation. ( GP , )
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Clinicians should consider using the continuous CHADS2 or continuous CHA2DS2-VASc for prediction of risk of stroke ( W , L )
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and HAS-BLED for prediction of risk for bleeding. (, )
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in patients who have atrial fibrillation.
Clinicians should discuss the risk of stroke and bleeding with all patients considering anticoagulation ( GP , )
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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. (, )
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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.
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Dual treatment with anticoagulant and antiplatelet therapy is NOT recommended for most patients who have atrial fibrillation. ( S , M )
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Title
Pharmacological Management Of Newly Detected Atrial Fibrillation
Authoring Organization
American Academy of Family Physicians
Publication Month/Year
April 1, 2017
Last Updated Month/Year
March 20, 2024
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