1 Dec 2023 • The latest ACC/AHA 2023 clinical guidelines deliver updated recommendations for optimally managing AF. The following Top 10 Take-Home Messages represent the most impactful changes in these recommendations compared with previous guidelines and address known gaps in clinical practice.

1. Stages of atrial fibrillation (AF): The new proposed classification, using stages, recognizes AF as a disease continuum that requires a variety of strategies at the different stages, from prevention, lifestyle and risk factor modification, screening, and therapy.

2. AF risk factor modification and prevention: The guideline emphasizes risk factor management throughout the disease continuum including management of obesity, weight loss, physical activity, smoking cessation, alcohol moderation, hypertension, and other comorbidities.

3. Flexibility in using clinical risk scores and expanding beyond CHA2DS2-VASc for prediction of stroke and systemic embolism: Patients at an intermediate annual risk score who remain uncertain about the benefit of anticoagulation can benefit from consideration of other risk variables to help inform the decision, or the use of other clinical risk scores to improve prediction, facilitate shared decision making, and incorporate into the electronic medical record.

4. Consideration of stroke risk modifiers: Patients with AF at intermediate to low (<2%) annual risk of ischemic stroke can benefit from consideration of factors that might modify their risk of stroke, such as the characteristics of their AF (eg, burden), nonmodifiable risk factors (sex), and other dynamic or modifiable factors (blood pressure control) that may inform shared decision-making discussions.

5. Early rhythm control: With the emergence of new and consistent evidence, this guideline emphasizes the importance of early and continued management of patients with AF that should focus on maintaining sinus rhythm and minimizing AF burden.

6. Catheter ablation of AF receives a Class 1 indication as first-line therapy in selected patients

7. Catheter ablation of AF in appropriate patients with heart failure with reduced ejection fraction receives a Class 1 indication

8. Recommendations have been updated for device-detected AF: In view of recent studies, more prescriptive recommendations are provided for patients with device-detected AF that consider the interaction between episode duration and the patient’s underlying risk for thromboembolism. This includes considerations for patients with AF detected via implantable devices and wearables.

9. Left atrial appendage occlusion devices receive higher level Class of Recommendation

10. Recommendations are made for patients with AF identified during medical illness or surgery (precipitants): Emphasis is made on the risk of recurrent AF after AF is discovered during noncardiac illness or other precipitants, such as surgery.

Source: ACC | Read full story