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.
