Guidance on the diagnosis and management of atrial fibrillation, the most common arrhythmia, is being updated by the National Institute for Health and Care Excellence.
NICE published a draft guideline for public consultation last week. It seeks to address several areas where new evidence has become available since previous guidance was published in 2006. These areas include stroke and bleeding risk calculation, the role of new anticoagulants and ablation.
The draft document recommends that clinicians should offer rate control as the first-line strategy to all people with atrial fibrillation and refer “promptly” if treatment fails to control symptoms.
They should use the CHA2DS2-VASc stroke risk score to assess stroke risk in people with atrial fibrillation, atrial flutter or a continuing risk of arrhythmia recurrence. Those with a risk score of 2 or above should be offered anticoagulation.
NICE added that the HAS-BLED score should be used to assess the risk of bleeding in patients starting anticoagulation and to “highlight, correct and monitor” modifiable risk factors such as uncontrolled hypertension, concurrent medication or harmful alcohol consumption.
The draft guideline on atrial fibrillation management will be available for consultation until 26 February, with final guidance due in June.
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