The American College of Cardiology (ACC) and the American Heart Association (AHA) on November 30, 2023, released new guidance for prevention and optimal management of atrial fibrillation (AF).
The guidelines, jointly published in the Journal of the American College of Cardiology and Circulation, for the first time provide a classification system for AF, the 4 stages reflecting the complexity of the condition and the need for a continuum of care that includes different strategies at different stages.
In this 10-slide Guideline Topline find summaries of the 10 take-home messages offered by the ACC/AHA from the first full update of AF guidelines since 2014.
The AHA and ACC collaborated with, and the publication is endorsed by the American College of Clinical Pharmacy and the Heart Rhythm Society.
1. The 4 stages of atrial fibrillation recognize AF as a disease continuum requiring a variety of strategies at each stage.
2. Atrial fibrillation risk factor modification and prevention are pillars of AF management and emphasized at all stages of the disease.
3. Clinical risk score flexibility & expanding beyond CHA2DS2-VASc for stroke and systemic embolism prediction are now recommended to ensure optimal prediction of individual risk.
4. Consideration of stroke risk modifiers should be included in assessment when the annual risk of ischemic stroke is intermediate to low.
5. Early and continued rhythm control is recommended, focused on maintaining sinus rhythm and minimizing disease burden.
6. Catheter ablation now has Class 1 indication as first-line therapy in select patients, eg, those with persistent and paroxysmal AF.
7. Catheter ablation in appropriate patients with HFrEF upgraded to Class 1 indication based on demonstrated superiority over drug therapy.
8. Updated recommendations for device-detected AF are more prescriptive and take into consideration the interaction between episode duration and underlying risk for thromboembolism.
9. Left atrial appendage occlusion devices receive higher Class of Recommendation for patients with contraindications for long-term anticoagulation therapy.
10. Recommendations are included for AF identified during medical illness or surgery that focus on patient counseling on recurrence and outpatient follow-up for risk assessment.
Source: Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. Published online November 30, 2023. doi:10.1161/CIR.0000000000001193
