Management Strategies for Patients with AFib
Atrial Fibrillation (AFib)
Management Strategies for Patients With AFib
Atrial fibrillation’s (AFib’s) complex etiology, progressive nature, and varied presentation provide compelling reasons for health care providers to carefully determine each patient’s management strategy.1
Published guidelines provide guidance in the optimal management of AFib. The guidelines call for patient-specific approaches designed to decrease the patient’s risk of stroke, control heart rate to provide symptomatic relief, and restore sinus rhythm to discourage progression of the disease.2
Initiating Risk-Based Stroke Prevention
• AFib significantly increases the risk of thromboembolic ischemic stroke, and the increased risk is independent of whether the patient is symptomatic or asymptomatic, or the duration of AFib episodes.2
• Because of the increased stroke risk, an individualized antithrombotic therapy should be developed for each AFib patient based on the risk of stroke, patient values, and patient preferences.2
• Assessing a patient’s risk of stroke should be based upon the CHA2DS2-VASc score,2 a numeric representation of the incidence of stroke risk factors.3
• The patient’s continued need for antithrombotics, and the choice of antithrombotics to be used, should be re-evaluated at regular intervals.2
• The risk of stroke can be decreased by as much as approximately 60% with anticoagulant therapy.4
Controlling Heart Rate Is Important
• Heart rate control is an important goal for AFib patients, as it affects the patient’s quality of life, reduces morbidity, decreases the potential for
developing cardiomyopathy, and is a means of alleviating symptoms.2
• Control of the ventricular rate using medication is recommended for patients with paroxysmal, persistent, or permanent AFib.2
• In patients who experience AFib-related symptoms during activity, control of the heart rate should be assessed during activity.2
Restoring Heart Rhythm to Slow AFib Progression
• AFib is a progressive disease that leads to electrical, contractile, and structural remodeling in the heart,1 and these changes become irreversible over time.2
• Conversion to sinus rhythm is the ideal endpoint in the treatment of AFib.1 Long-term AFib management should be based on the restoration and maintenance of sinus rhythm in combination with appropriate anticoagulation and heart rate control.2
• Therapy should be started as close to diagnosis as possible because early interventions with a rhythm-control strategy may be beneficial in discouraging the progression of the disease.1,2
• Patients who had antiarrhythmic medications prescribed in accordance with 2014 AHA/ACC/HRS guidelines achieved better heart rhythm control, had less AFib recurrence, fewer hospitalizations, and required fewer AFib-related procedures than patients who were treated using therapies inconsistent with the guidelines.5
1. Van Gelder IC, Hemels ME. The progressive nature of atrial fibrillation: a rationale for early restoration and maintenance of sinus rhythm. Europace. 2006;Nov;8(11):943-949.
2. January CT, Wann LS, Alpert JS, et al. 2014;AHA/ACC/HRS guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. Circulation. 2014;Dec 2;130(23):e199-e267.
3. Lane DA, Lip GY. Use of the CHA(2)DS(2)-VASc and HAS-BLED scores to aid decision making for thromboprophylaxis in nonvalvular atrial fibrillation. Circulation. 2012;Aug 14;126(7):860-865.
4. Goldstein LB, Adams R, Alberts MJ, et al. Primary prevention of ischemic stroke: a guideline from the American Heart Association/American Stroke Association Stroke Council: cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. 2006;Jun 20;113(24):e873-923.
5. Qin D, Leef G, Alam MB, et al. Patient outcomes according to adherence to treatment guidelines for rhythm control of atrial fibrillation. J Am Heart Assoc. 2015;Apr 6;4(4). http://jaha.ahajournals.org/content/4/4/e001793.full.pdf. Accessed May 28, 2015.
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