2
Overview
Top 10 Take-Home Messages for Atrial Fibrillation
1. Stages of atrial fibrillation (AF): The previous classification of AF,
which was based only on arrhythmia duration, although useful,
tended to emphasize therapeutic interventions. The new proposed
classification, using stages, recognizes AF as a disease continuum
that requires a variety of strategies at the different stages, from
prevention, lifestyle and risk factor modification (LRFM), screening,
and therapy.
2. AF risk factor modification and prevention: This guideline
recognizes lifestyle and risk factor modification as a pillar of AF
management to prevent onset, progression, and adverse outcomes.
The guideline emphasizes risk factor management throughout the
disease continuum and offers more prescriptive recommendations,
accordingly, including management of obesity, weight loss, physical
activity, smoking cessation, alcohol moderation, hypertension, and
other comorbidities.
3. Flexibility in using clinical risk scores and expanding beyond
CHA
2
DS
2
-VASc for prediction of stroke and systemic embolism:
Recommendations for anticoagulation are now made based on yearly
thromboembolic event risk using a validated clinical risk score, such
as CHA
2
DS
2
-VASc. However, patients at an intermediate annual risk
score who remain uncertain about the benefit of anticoagulation
can benefit from consideration of other risk variables to help inform
the decision, or the use of other clinical risk scores to improve
prediction, facilitate shared decision making, and incorporate into
the electronic medical record.
4. Consideration of stroke risk modifiers: Patients with AF at
intermediate to low (<2%) annual risk of ischemic stroke can benefit
from consideration of factors that might modify their risk of stroke,
such as the characteristics of their AF (eg, burden), nonmodifiable
risk factors (sex), and other dynamic or modifiable factors (blood
pressure control) that may inform shared decision-making (SDM)
discussions.
5. Early rhythm control: With the emergence of new and consistent
evidence, this guideline emphasizes the importance of early and
continued management of patients with AF that should focus on
maintaining sinus rhythm and minimizing AF burden.
