AAFP Guidelines Bundle

Atrial Fibrillation - Pharmacological Management

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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 CHADS 2 or continuous CHA 2 DS 2 -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.

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