New guidelines update treatment options for atrial fibrillation

People with atrial fibrillation should work closely with their doctors to treat the condition, using a more detailed stroke-risk assessment tool and careful consideration about aspirin or blood-thinning drugs, according to new treatment guidelines released Friday by the American Heart Association and American College of Cardiology.

More than 2.7 million Americans live with atrial fibrillation, or AFib, a quivering or irregular heartbeat that can lead to blood clots causing stroke, heart failure and other complications.

The guidelines are used by healthcare providers in their treatment decisions, reflecting new research and scientific information about treatment and control of AFib. The new guidelines recommend an overall approach of ongoing discussions with patients about the best treatments.

One of the most significant recommendations is a more comprehensive stroke risk assessment tool that gives healthcare providers a better understanding of a person’s risk for stroke.

The risk assessment tool that is commonly used now, known as “CHADS₂ ,” takes into account whether someone is at risk due to congestive heart failure, high blood pressure, age (75 or older), diabetes and stroke. The tool recommended in the new guidelines, called “CHA₂DS₂-VASc,” also considers whether a patient has had prior vascular disease, evaluates people at younger ages (between 65–74) and factors in gender. This is important because women face higher stroke risks.

Aspirin has previously been prescribed to people with AFib who had a low stroke risk. But the guideline writing group, made up of experts in the field, didn’t find sufficient data to continue supporting that recommendation in most cases.

Coumadin (warfarin) has long been the drug of choice in blood thinners for AFib patients, but the proper dosing is often hard to manage in some people and taking Coumadin requires frequent blood testing. Several new anticoagulants have been approved over the past two years, and the new guidelines offer options for using dabigatran, rivaroxaban and apixaban as deemed appropriate by the treating doctor. 

The guidelines encourage discussions between the patient and physician regarding specific care and treatments.

The guidelines also discuss the use of radio frequency ablation in treating AFib in certain patients with atrial fibrillation. During this minimally invasive procedure, the doctor uses radiofrequency waves to destroy tiny areas in the heart that are firing off abnormal electrical impulses causing the rhythm disorder. This and other surgical procedures are being used more effectively in treating and controlling AFib.

The guidelines build on and update those released in 2006 and further updated in 2011, and will continue to be evaluated and revised as more information is gained through further research.