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AHA/ACC/Heart Rhythm Society release updated AF management guideline
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The American Heart Association, American College of Cardiology and Heart Rhythm Society have released the 2014 Guideline for the Management of Patients with Atrial Fibrillation.
The update, published in the Journal of the American College of Cardiology, Circulation and Heart Rhythm, is intended to supersede the guideline released by the organizations in 2006, as well as two focused updates released during 2011. It is the product of a consensus among clinicians across a range of expertise, including adult cardiology, cardiothoracic surgery, electrophysiology and HF, according to a press release.
Major new recommendations within this new guideline include a call for increased use of radiofrequency ablation to treat nonvalvular AF, an additional three novel anticoagulants as potential treatment options, a reduction in the role of aspirin for treatment in this population, and the use of the CHA2DS2-VASc calculator to assess thromboembolic risk.
The call for increased use of radiofrequency ablation for AF treatment follows favorable results from the use of the treatment since the previous version of the guidelines. “As experience with [radiofrequency] ablation grows, there has been an increased recognition that it can be used effectively as an AF treatment,” Craig T. January, MD, PhD, writing committee chair and professor of medicine in the Cardiovascular Medicine division at the University of Wisconsin-Madison, said in the release.
Along with warfarin (Coumadin, Bristol-Myers Squibb), which had been the only anticoagulant recommended for use by prior guidelines, the new guideline now also recommends the use of apixaban (Eliquis, Bristol-Myers Squibb and Pfizer), dabigatran (Pradaxa, Boehringer Ingelheim) and rivaroxaban (Xarelto, Janssen Pharmaceuticals). “Because what we say in the guideline can affect how a drug is used, we were careful to be even-handed and evidence-based in presenting new drugs,” January said in the release. “Our goal was to provide useful, non-biased information.”
The new guideline also calls for the use of the more detailed CHAD2DS2-VASc risk calculator when determining a patient’s risk for stroke. This calculator is more comprehensive and provides more information than that recommended for use in previous versions of the guidelines, according to the release.
The prior version recommended the prescription of aspirin among patients with AF and a low risk for stroke. However, the data indicating a reduction in risk for stroke with aspirin use is weak, January said in the release.