Clinical guidlines for atrial fibrillation

Australia's first guidelines for the diagnosis and management of adult patients with atrial fibrillation (AF), released by the Heart Foundation and the Cardiac Society of Australia and New Zealand (CSANZ), aim to have a major impact on the condition that causes a third of all strokes in Australia.

AF is linked to 1 in 11 deaths in Australia and is the most common recurrent arrhythmia faced in clinical practice, but its incidence is underestimated because many people do not realise they have it.  A major cause of stroke, AF is projected to double over the next 20 years in Australians aged 55 years and over, while deaths from AF have increased by 82% over the past 10 years.

Heart Foundation chief medical adviser, cardiologist Professor Garry Jennings, said the guidelines aim to have a significant impact on Australians living with AF through evidence-based recommendations on its screening, diagnosis and treatment. "More than half a million Australians currently live with atrial fibrillation, and the condition has a substantial effect on patients' well-being," Professor Jennings said. "But its incidence is underestimated because many patients don't have clinical symptoms. This means AF is often only discovered once it triggers serious consequences, such as stroke.

"The guidelines offer advice in a local context and are based on new and emerging evidence on issues such as the complexities of using newer anticoagulants to prevent stroke, and the patients in whom catheter ablation is recommended.

"The guidelines also advise on the need to prevent, detect and manage several risk factors that can cause AF and increase its complications, including hypertension, diabetes, heart failure, valvular heart disease, and alcohol excess."

From a public health perspective, AF imposes a growing burden on healthcare resources. AF hospitalisations are increasing at a far greater rate than hospitalisations for other cardiovascular conditions, with 10-30% of AF patients admitted to hospital each year.   

Stroke Foundation Clinical Council Chair Associate Professor Bruce Campbell said patients with AF were up to five times more likely to have a stroke than the general community. "Patients with AF are not only more likely to have a stroke, but the strokes caused by AF are more commonly severe or fatal than other ischaemic stroke (caused by a clot) subgroups, so detecting and treating this dangerous condition is vital to a person's health," A/Prof Campbell said.

 "This Australian-first guideline supports health professionals to better assess patient needs for stroke prevention strategies to significantly reduce the occurrence of stroke caused by AF."

Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018.

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