New Guidelines for Atrial Fibrillation: 4 Big Changes

Dr. Sharon Orrange
Dr. Orrange is an Associate Professor of Clinical Medicine in the Division of Geriatric, Hospitalist and General Internal Medicine at the Keck School of Medicine of USC.
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Almost 6 million Americans have the irregular heart rhythm atrial fibrillation. Atrial fib increases your risk of stroke, heart failure, dementia, and early mortality. New guidelines have just been released, with some pretty big changes on how to manage atrial fib. Here is what you need to know:

1. Know the score.

The decision of whether or not you need to be on blood thinners when you have atrial fib has always been based on your score. Your risk of stroke when you have atrial fib will now be calculated using a new scoring system. The CHA2DS2-VASc (you can look online and find it) helps decide who needs to be on blood thinners for atrial fib and who doesn’t. One point each is given for heart failure, high blood pressure, diabetes, vascular disease, age 65 to 74, female sex, and two points each for age 75 or older and prior stroke/transient ischemic attack.

2. The role of aspirin, diminished.

Folks with atrial fibrillation who we don’t place on blood thinners used to be told to take an aspirin a day. Aspirin carries with it a bleeding risk and many studies show either no benefit or weak benefit in terms of stroke reduction in patients with atrial fib.

3. Bring in the new.

For many years, the only anticoagulant recommended was Coumadin (warfarin). Now, the guidelines include recommendations for the three new anticoagulants for nonvalvular atrial fibrillation. Nonvalvular means you have no known moderate to severe regurgitation (the valve doesn’t close properly) or stenosis (narrowing of the valve) of your mitral, aortic or tricuspid valve. For patients with nonvalvular atrial fib with prior stroke, or a CHA2DS2-VASc score of 2 or greater, oral anticoagulants (blood thinners) are recommended. Options include warfarin, Pradaxa, Xarelto or Eliquis. Cost is a barrier to widespread use of the newer oral anticoagulants as they will be much more expensive than warfarin.

4. Zap

The fourth important change is a more prominent role for radio-frequency ablation in the treatment of atrial fib. In patients with recurrent symptomatic atrial fib, catheter ablation is a reasonable initial strategy prior to starting on medications to control rhythm (Multaq, etc).

Dr O.

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