Access the activity, “Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,” at PeerView.com/NTH40 AAFP Updated Guideline on Pharmacologic Management of Newly Detected Atrial Fibrillation 1 PRACTICE AID AAFP: American Academy of Family Physicians; AF: atrial fibrillation; CHA 2 DS 2 -VASc: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/ thromboemolic event, vascular disease, age 65 to 74 years, sex category; CHADS 2 : congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/ thromboembolic event; HAS-BLED: hypertension, abnormal renal and liver function, stroke history, bleeding (prior major bleeding or predisposition to bleeding), labile INR, elderly (age >65 years), medication usage predisposing to bleeding and prior alcohol or drug usage history. 1. https://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/a-fib-guideline.pdf. Accessed March 3, 2020. Recommendation 1 The AAFP strongly recommends rate control in preference to rhythm control for the majority of patients with AF Preferred options for rate-control therapy include non-dihydropyridine calcium channel blockers and β-blockers Rhythm control may be considered for certain patients based on symptoms, exercise tolerance, and patient preferences Recommendation 2 The AAFP recommends lenient rate control (<110 bpm at rest) over strict rate control (<80 bpm at rest) for patients with atrial fibrillation Recommendation 3 The AAFP recommends that clinicians discuss the risk of stroke and bleeding with all patients considering anticoagulation Clinicians should consider using the continuous CHADS 2 or continuous CHA 2 DS 2 -VASc for prediction for risk of stroke and HAS-BLED for prediction of risk for bleeding in patients with AF Recommendation 4 The AAFP strongly recommends that patients with atrial fibrillation receive chronic anticoagulation unless they are at low risk of stroke (CHADS 2 <2) or have specific contraindications Choice of anticoagulation therapy should be based on patient preferences and patient history. Options for anticoagulant therapy may include warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban Recommendation 5 The AAFP strongly recommends against dual treatment with anticoagulant and antiplatelet therapy in most patients who have atrial fibrillation Strong recommendation, high-quality evidence Strong recommendation, moderate-quality evidence Weak recommendation, low-quality evidence Good practice point
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Access the activity, “Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,” at PeerView.com/NTH40
AAFP Updated Guideline on Pharmacologic Management of Newly Detected Atrial Fibrillation1
PRACTICE AID
AAFP: American Academy of Family Physicians; AF: atrial fibrillation; CHA2DS2-VASc: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboemolic event, vascular disease, age 65 to 74 years, sex category; CHADS2: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolic event; HAS-BLED: hypertension, abnormal renal and liver function, stroke history, bleeding (prior major bleeding or predisposition to bleeding), labile INR, elderly (age >65 years), medication usage predisposing to bleeding and prior alcohol or drug usage history.
1. https://www.aafp.org/dam/AAFP/documents/patient_care/clinical_recommendations/a-fib-guideline.pdf. Accessed March 3, 2020.
Recommendation 1 The AAFP strongly recommends rate control in preference to rhythm control for themajority of patients with AF
Preferred options for rate-control therapy include non-dihydropyridine calcium channelblockers and β-blockers
Rhythm control may be considered for certain patients based on symptoms, exercisetolerance, and patient preferences
Recommendation 2 The AAFP recommends lenient rate control (<110 bpm at rest) over strict rate control (<80 bpm at rest) for patients with atrial fibrillation
Recommendation 3 The AAFP recommends that clinicians discuss the risk of stroke and bleeding with allpatients considering anticoagulation
Clinicians should consider using the continuous CHADS2 or continuous CHA2DS2-VAScfor prediction for risk of stroke and HAS-BLED for prediction of risk for bleeding in patientswith AF
Recommendation 4 The AAFP strongly recommends that patients with atrial fibrillation receive chronicanticoagulation unless they are at low risk of stroke (CHADS2 <2) or have specificcontraindications
Choice of anticoagulation therapy should be based on patient preferences and patienthistory. Options for anticoagulant therapy may include warfarin, apixaban, dabigatran,edoxaban, or rivaroxaban
Recommendation 5 The AAFP strongly recommends against dual treatment with anticoagulant andantiplatelet therapy in most patients who have atrial fibrillation
Atrial Fibrillation Screening: Risk Calculators, Tools, and Additional Resources
PRACTICE AID
Access the activity, “Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,” at PeerView.com/NTH40
Risk Factor Points
CHF 1
Hypertension 1
Age ≥75 years 1
Diabetes mellitus 1
Stroke/TIA/embolism 2
Maximum score 6
Risk Factor Points
CHF/LV dysfunction 1
Hypertension 1
Age ≥75 years 2
Diabetes mellitus 1
Stroke/TIA/embolism 2
Vascular disease 1
Age 65-74 years 1
Sex category (female) 1
Maximum score 9
Clinical Characteristic Points
H Hypertension 1
A Abnormal liver and/orrenal function
1 each;max. of 2
S Stroke 1
B Bleeding 1
L Labile INR 1
E Elderly (age >65) 1
D Drugsa and/or alcohol 1 each;max. of 2
Maximum score 9
CHADS2 Risk Score forPrediction of Stroke Risk in AF
CHA2DS2-VASc Risk Score forPrediction of Stroke Risk in AF
HAS-BLED Risk Calculator forPredicting Risk of Bleeding
With Anticoagulation
Additional Resources for Physicians• NATF Atrial Fibrillation Action Initiative• NATF AF Action Initiative Document• Arrhythmia Alliance Homepage• Arrhythmia Alliance “AF and How AF Causes Stroke” (video)• AAFP Clinical Practice Guideline on Atrial Fibrillation
a Aspirin/NSAIDs.
Atrial Fibrillation Screening: Risk Calculators, Tools, and Additional Resources
AAFP: American Academy of Family Physicians; AF: atrial fibrillation; BP: blood pressure; CHA2DS2-VASc: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboemolic event, vascular disease, age 65 to 74 years, sex category; CHADS2: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolic event; HAS-BLED: hypertension, abnormal renal and liver function, stroke history, bleeding (prior major bleeding or predisposition to bleeding), labile INR, elderly (age >65 years), medication usage predisposing to bleeding and prior alcohol or drug usage history; INR: International Normalized Ratio; LV: left ventricular; NATF: North American Thrombosis Forum.
1. https://www.microlife.com/consumer-products/blood-pressure/upper-arm-automatic/bp-a200-afib. Accessed March 3, 2020.2. https://www.cnet.com/news/best-blood-pressure-monitors-for-at-home-use/. Accessed March 3, 2020.3. https://www.mobihealthnews.com/news/north-america/verily-irhythm-ink-deal-create-fib-screening-diagnosis-tools. Accessed March 3, 2020. 4. Sandesara CM et al. J Innov Card Rhythm Manag. 2017;8:2824-2834.
PRACTICE AID
Access the activity, “Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,” at PeerView.com/NTH40