The latest guidelines from the European Society of Cardiology (ESC) have recently been published during the ESC Congress in London. The new guidelines recommend the implementation of the "AF-CARE" strategy for the management of Atrial Fibrillation (AF).
C - Comorbidity and risk factor management
A - Avoid stroke and thromboembolism
R - Reduce symptoms by rate and rhythm control
E - Evaluation and dynamic reassessment
Comorbidity and risk factor management involves addressing other health conditions that can cause and worsen AF, or affect the success of treatments. This involves: Treating high blood pressure with the aim for a BP less than 130/80, better blood sugar control in diabetes, medicines to be used if needed to control heart failure, a reduction in alcohol intake with a recommendation of 3 or less drinks per week as well as regular exercise and weight loss if overweight (aiming to loose 10% of body weight).
Avoiding stroke and thromboembolism involves lowering the chance of blood clots related to AF with the use of blood thinners ( called DOACs, such as apixaban, some times patients may need warfarin). While patients should also be assessed for bleeding risks, this should not be used to withhold DOACs, in stead measures should be taken to reduce the risk of bleeding, including tight BP control, reducing alcohol intake and avoiding unnecessary medication such as NSAIDs (associated with an increased risk of bleeding).
Reducing symptoms by rate and rhythm control involves specific treatments to help manage AF by using medication to control the heart rate, or by restoration to normal sinus rhythm. This can be achieved either with the use of drugs or with electrical treatments to restore normal rhythm such as cardioversion or ablation (key hole surgery). These treatments are designed to improve symptoms but in selective groups rhythm control may also improve life expectancy (for example if patients are treated early after going into AF or patient with heart failure thought to be secondary to AF (called tachycardiomyopathy).
Evaluation and dynamic reassessment involves your care adapting to how your AF can change over time in order to better prevent complications. Investigations such as ECGs, blood tests and heart ultrasound scans can be used as well as an ongoing follow up by your healthcare professional with expertise in AF (Cardiologist). Follow up should ideally occur during any deterioration in AF or during hospitalisation and should continue on an annual basis thereafter.
View the full new Guidelines here: https://www.escardio.org/static-file/Escardio/Guidelines/Documents/ESC-Patient-Guidelines-Atrial-Fibrillation.pdf
If you would like to contact me in order to organize an appointment to discuss AF or any other cardiac condition, please contact my secretary at drkhianisec@medserv.co.uk
Commentaires