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New Guidelines for Atrial Fibrillation

Close to 3 million Americans are living with atrial fibrillation (AFib), or an irregular or quivering heartbeat, and this number is expected to shoot up in the next decade because of rising obesity and an increasing lifespan. The condition is linked to a higher risk of stroke, heart failure, cognitive decline and dementia.

The newest guidelines for treating patients with AFib address a variety of issues such as the use of blood thinners to prevent stroke and the importance of weight loss and weight management aimed at improving the long-term outcomes for patients with the disorder.

The 2019 American College of Cardiology/American Heart Association/Heart Rhythm Society Guidelines for the Management of Patients with Atrial Fibrillation have just been published in Circulation, the Journal of the American College of Cardiology, and HeartRhythm as the standard for the management of AFib in the United States.

Why Are The New Guidelines Important?

Lin Yee Chen, MD, MS, Associate Professor with Tenure in the Cardiovascular Division in the Department of Medicine with the University of Minnesota Medical School was a member of the committee that updated the previous guidelines for patients with AFib, which dated from 2014.  

“For clinicians, no matter what your specialty, you will encounter AFib because it is so common,” Dr. Chen says. “These guidelines are written for all physicians in all specialties.”

It’s important for health care providers to learn about the new guidelines no matter what their specialty, concurs Andrea Natale, MD, cardiac electrophysiologist and executive medical director of the Texas Cardiac Arrhythmia Institute at David’s Medical Center.

“If you are in internal medicine, it is important for you to be aware of the guidelines since you may be the first to see these patients and it is up to you to make sure the basics are covered to save the patient from some tragic event such as a stroke,” Dr. Natale says. “If a blood thinner is needed, this could be a decision made by a primary care physician before he is referred to and seen by a cardiologist.”

What Do The Guidelines Say?

The biggest change in the new guidelines, Dr. Natale says, is the information on lifestyle changes. “The guidelines discuss not just losing weight but sleep apnea, diabetes management, and controlling blood pressure,” he says. “The patients need to be motivated to monitor not just their weight, but also their blood sugar and arterial pressure, as well as strive to reach their goal weight.”

Sleep apnea is one of the biggest issues among patients with AFib, Dr. Natale notes, and it is important that patients living with the condition comply with treatment.

Also noteworthy in the 2019 Guidelines is the section on blood thinners, Dr. Chen says.  “There is a whole section on blood thinners,” he explains. “There are four new blood thinners that have been FDA approved. A big part of the 2019 guidelines is focused on the use of this type of blood thinner as relates to AFib. The new guidelines help determine how and when to use these new agents, including in a situation that involves surgery.”A new section on weight loss discusses new data that demonstrate the beneficial effects of weight loss and risk factor modification on controlling AFib.  Another new section in the Guidelines, Device Detection of AF and Atrial Flutter, contains Recommendations for Device Detection of AFib and Atrial Flutter.

2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation, Circulation.

Last updated on 9/30/19.

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