National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018

David Brieger, John Amerena, John R. Attia, Beata Bajorek, Kim H. Chan, Cia Connell, Ben Freedman, Caleb Ferguson, Tanya Hall, Haris M. Haqqani, Jeroen Hendriks, Charlotte M. Hespe, Joseph Hung, Jonathan M. Kalman, Prashanthan Sanders, John Worthington, Tristan Yan, Nicholas A. Zwar

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Abstract

INTRODUCTION: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.

Original languageEnglish
Pages (from-to)356-362
Number of pages7
JournalThe Medical journal of Australia
Volume209
Issue number8
DOIs
Publication statusPublished - 15 Oct 2018
Externally publishedYes

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Atrial Fibrillation
Guidelines
Anticoagulants
Stroke
Flecainide
Electric Countershock
Amiodarone
Telemedicine
Calcium Channel Blockers
Warfarin
Patient Education
Therapeutics
Practice Guidelines
Cardiac Arrhythmias
Patient Care
Morbidity
Mortality

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Brieger, David ; Amerena, John ; Attia, John R. ; Bajorek, Beata ; Chan, Kim H. ; Connell, Cia ; Freedman, Ben ; Ferguson, Caleb ; Hall, Tanya ; Haqqani, Haris M. ; Hendriks, Jeroen ; Hespe, Charlotte M. ; Hung, Joseph ; Kalman, Jonathan M. ; Sanders, Prashanthan ; Worthington, John ; Yan, Tristan ; Zwar, Nicholas A. / National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand : Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. In: The Medical journal of Australia. 2018 ; Vol. 209, No. 8. pp. 356-362.
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abstract = "INTRODUCTION: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.",
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Brieger, D, Amerena, J, Attia, JR, Bajorek, B, Chan, KH, Connell, C, Freedman, B, Ferguson, C, Hall, T, Haqqani, HM, Hendriks, J, Hespe, CM, Hung, J, Kalman, JM, Sanders, P, Worthington, J, Yan, T & Zwar, NA 2018, 'National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018' The Medical journal of Australia, vol. 209, no. 8, pp. 356-362. https://doi.org/10.5694mja18.00646

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand : Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. / Brieger, David; Amerena, John; Attia, John R.; Bajorek, Beata; Chan, Kim H.; Connell, Cia; Freedman, Ben; Ferguson, Caleb; Hall, Tanya; Haqqani, Haris M.; Hendriks, Jeroen; Hespe, Charlotte M.; Hung, Joseph; Kalman, Jonathan M.; Sanders, Prashanthan; Worthington, John; Yan, Tristan; Zwar, Nicholas A.

In: The Medical journal of Australia, Vol. 209, No. 8, 15.10.2018, p. 356-362.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Connell, Cia

AU - Freedman, Ben

AU - Ferguson, Caleb

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AU - Hendriks, Jeroen

AU - Hespe, Charlotte M.

AU - Hung, Joseph

AU - Kalman, Jonathan M.

AU - Sanders, Prashanthan

AU - Worthington, John

AU - Yan, Tristan

AU - Zwar, Nicholas A.

PY - 2018/10/15

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N2 - INTRODUCTION: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work-up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β-Blockers or non-dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2-VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non-vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.

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