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2.1 What is new

Table 3 New recommendations

Classa Levelb

Diagnostic evaluation of new AF—Section 3.4

A transthoracic echocardiogram is recommended in patients with an AF diagnosis where this will guide treatment decisions. I C Principles of AF-CARE—Section 4.2 Education directed to patients, family members, caregivers, and healthcare professionals is recommended to optimize shared decision-making, facilitating open discussion of both the benefit and risk associated with each treatment option. I C Access to patient-centred management according to the AF-CARE principles is recommended in all patients with AF, regardless of gender, ethnicity, and socioeconomic status, to ensure equality in healthcare provision and improve outcomes. I C Patient-centred AF management with a multidisciplinary approach should be considered in all patients with AF to optimize management and improve outcomes. IIa B [C] Comorbidity and risk factor management—Section 5 Diuretics are recommended in patients with AF, HF, and congestion to alleviate symptoms and facilitate better AF management. I C Appropriate medical therapy for HF is recommended in AF patients with HF and impaired LVEF to reduce symptoms and/or HF hospitalization and prevent AF recurrence. I B Sodium-glucose cotransporter-2 inhibitors are recommended for patients with HF and AF regardless of left ventricular ejection fraction to reduce the risk of HF hospitalization and cardiovascular death. I A Effective glycaemic control is recommended as part of comprehensive risk factor management in individuals with diabetes mellitus and AF, to reduce burden, recurrence, and progression of AF. I C Bariatric surgery may be considered in conjunction with lifestyle changes and medical management in individuals with AF and body mass index ≥40 kg/m2 c where a rhythm control strategy is planned, to reduce recurrence and progression of AF. IIb C Management of obstructive sleep apnoea may be considered as part of a comprehensive management of risk factors in individuals with AF to reduce recurrence and progression. IIb B When screening for obstructive sleep apnoea in individuals with AF, using only symptom-based questionnaires is not recommended. III B Initiating oral anticoagulation—Section 6.1 Oral anticoagulation is recommended in patients with clinical AF at elevated thromboembolic risk to prevent ischaemic stroke and thromboembolism. I A A CHA2DS2-VA score of 2 or more is recommended as an indicator of elevated thromboembolic risk for decisions on initiating oral anticoagulation. I C A CHA2DS2-VA score of 1 should be considered an indicator of elevated thromboembolic risk for decisions on initiating oral anticoagulation. IIa C Oral anticoagulation is recommended in all patients with AF and hypertrophic cardiomyopathy or cardiac amyloidosis, regardless of CHA2DS2-VA score, to prevent ischaemic stroke and thromboembolism. I B Individualized reassessment of thromboembolic risk is recommended at periodic intervals in patients with AF to ensure anticoagulation is started in appropriate patients. I B Direct oral anticoagulant therapy may be considered in patients with asymptomatic device-detected subclinical AF and elevated thromboembolic risk to prevent ischaemic stroke and thromboembolism, excluding patients at high risk of bleeding. IIb B Oral anticoagulants—Section 6.2 A reduced dose of DOAC therapy is not recommended, unless patients meet DOAC-specific criteria, to prevent underdosing and avoidable thromboembolic events. III B Maintaining VKA treatment rather than switching to a DOAC may be considered in patients aged ≥75 years on clinically stable therapeutic VKA with polypharmacy to prevent excess bleeding risk. IIb B Antiplatelet drugs and combinations with anticoagulants—Section 6.3 Adding antiplatelet treatment to oral anticoagulation is not recommended in AF patients for the goal of preventing ischaemic stroke or thromboembolism. III B

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