Updated atrial fibrillation guidelines focus on risk management and patient-centered care

The 2024 ESC Guidelines for the Management of Atrial Fibrillation, developed in collaboration with the European Association of Cardio-Thoracic Surgery (EACTS), include a number of new approaches and treatment-specific recommendations to help manage the rising number of patients with AF worldwide.

Atrial fibrillation (AF) is one of the most common cardiac diseases, with a broad impact on all healthcare services in primary, secondary and tertiary care. The prevalence of AF is expected to double by 2050 due to an aging population, an increasing burden of comorbidities, improved awareness and new technologies for detection.”

Isabelle C. Van Gelder, Professor of Guidelines, University Medical Center Groningen, Groningen, The Netherlands

“The impact of AF is variable in individual patients; however, morbidity due to AF remains of great concern,” added Professor Dipak Kotecha, chair of the guidelines, from the University of Birmingham, UK. “Patients with AF can suffer from a variety of symptoms and poor quality of life. Stroke and heart failure as consequences of AF are now well appreciated by healthcare professionals, but AF is also linked to a range of other thromboembolic outcomes. These include subclinical cerebral complications. damage (potentially leading to vascular dementia) and thromboembolism to any other organ, all of which contribute to the higher risk of death associated with AF.”

The 2024 guidelines emphasize the importance of optimal care according to the new AF-CARE pathway, which is designed to ensure that every patient with AF can benefit from recent scientific developments: [C] Comorbidity and risk factor management; [A] Avoid stroke and thromboembolism; [R] Reduce symptoms by speed and rhythm control; And [E] Evaluation and dynamic reassessment.

The new guidelines also emphasize the importance of shared decision-making about treatments and care, involving both patients and a multidisciplinary team. Emphasis is placed on educating patients, families and healthcare professionals to ensure that everyone is empowered to make the right treatment choice for each patient. There is also a focus on equal care, emphasizing the importance of avoiding health inequalities based on gender, ethnicity, disability and socio-economic factors.

“The sections on comorbidities in these new guidelines emphasize that AF cannot be seen in isolation. Thorough evaluation and management of comorbidities and risk factors are critical to all aspects of care for patients with AF to prevent recurrence and progression of AF, improve treatment success, and prevent AF-related adverse outcomes,” explains Professor Van Gelder out. “There should be more attention to the range of conditions and lifestyle factors where there is increasing evidence of impact on AF and patient care.”

The new guidelines also focus on recent clinical trials and research studies that could change the routine treatment of patients with AF for the better. “The guideline task force has carefully assessed the current evidence base, with patient pathways that can help achieve better implementation of recommendations to improve patient wellbeing,” said Professor Kotecha. Key new features include: (1) broader adoption of appropriate anticoagulation therapy and use of the CHA2DS2-VA score (without gender) to aid decision-making; (2) a safety-first approach, for example, by delaying cardioversion if AF duration exceeds 24 hours, or by fully considering all potential side effects of antiarrhythmic drugs; and (3) integrating rate and rhythm control, with shared decision-making regarding referral for catheter and surgical ablation.

The authors conclude by clarifying that dynamic evaluation and reassessment is necessary for patients with AF. They say, “Health care teams in primary and secondary care should periodically reassess therapy and pay attention to emerging modifiable risk factors that may slow or reverse the progression of AF, increase quality of life, and prevent adverse outcomes.” A patient version of the guidelines, co-written by the patient and public representatives of the task force, will be released at the same time.