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Update of Atrial Fibrillation Guideline

CardioSmart News

The American College of Cardiology, American Heart Association and Heart Rhythm Society in January released a new guideline on atrial fibrillation. Reflecting the latest research, it updates the guideline published in 2014. Here’s what you should know about the recommendations, and what they mean for people living with atrial fibrillation.

About Atrial Fibrillation

Atrial fibrillation, also called AFib, is the most common type of abnormal heart rhythm and affects more than 3 million  adults in the United States. It occurs when your heart beats too slowly, too quickly or in an irregular way. Atrial fibrillation can cause poor blood flow to the rest of your body. If you have AFib, you may feel:

  • Weakness 
  • Fatigue 
  • Shortness of breath 
  • Chest pain 
  • Palpitations 

Atrial Fibrillation also can make it more likely for you to develop blood clots, have a stroke, heart failure or other problems. You are at greater risk of having a stroke because when your heartbeat is out of sync, blood can pool in parts of your heart and form clots. Those blood clots can travel to the brain, which causes a stroke. Strokes related to AFib tend to be more severe and deadly. 

The good news is that finding out you have AFib and treating it early on can improve your quality of life and help you live longer. 

Diagnosis and Treatment

AFib can be found with several tests, such as a stress test, electrocardiogram or echocardiogram. These tests help monitor your heart’s activity and detect any abnormal heart rhythms that may occur.  

If you have AFib, treatment will depend on how severe your symptoms are and what the underlying cause is. Your treatment may include any combination of lifestyle changes, medication or procedures. The main goals are to stop abnormal heart rhythms and make it less likely for you to have a stroke.

2018 Guideline Updates

The latest guideline updates specific sections of the 2014 recommendations. Updates are based on new data as well as new guidance from the U.S. Food and Drug Administration. 

Blood Thinners  

An important change is that, in general, new blood thinners now are recommended over warfarin, the longtime standard choice of blood thinner. The newer options, often called NOACs (non-vitamin K oral anticoagulants), are easier to take than warfarin. They require less monitoring and often have fewer drug interactions. NOACs are as safe and effective as warfarin — if not more — studies show. 

However, these recommendations do not apply to patients who have a mechanical heart valve or severe mitral stenosis. If you have mitral stenosis, the valve on the left side of your heart cannot open as wide and so lets less blood through. 

Newly Approved Treatments

Two treatments have been added to the list of options to help people with atrial fibrillation. A new medicine called edoxaban has been cleared to prevent blood clots and stroke in patients with AFib. Edoxoban is also a NOAC (non-vitamin K oral anticoagulant).

Also, a new device called the Watchman device has been approved to help prevent stroke in patients at high risk who have problems with using blood thinners for the long term. The device is placed in a part of the heart to prevent blood clots from moving from the heart to the rest of the body.

Keep in mind that a number of factors help determine which treatment is best for you, such as your risk of stroke and your current treatments. You and your care team will talk about the options.

Lifestyle Changes

A number of lifestyle factors make it more likely for you to have AFib, such as having obesity or drinking too much alcohol. If you have sleep apnea, high blood pressure or diabetes, your chance of developing AFib also may be greater. Controlling or avoiding these conditions can help lower your chance of developing atrial fibrillation.

New studies suggest that addressing weight, sleep apnea and alcohol use also can help patients with AFib control their condition. In fact, research shows that if you are overweight or obese, the number of pounds you lose can affect how much your symptoms improve. The more weight you lose, the fewer symptoms of atrial fibrillation you may have. 

For more information, visit CardioSmart.org/AFib.

Read the full text of the Atrial Fibrillation Guideline Focused Update.

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