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NICE: Draft atrial fibrillation guidelines

Draft updated guidelines on the diagnosis and management of atrial fibrillation (AF) have been published by the National Institute for Health and Care Excellence (NICE).

AF is the most common arrhythmia seen in primary care, affecting around 1.5% of the population.

AF occurs when the electrical impulses controlling the heart rhythm become disorganised, so that the heart beats irregularly and, occasionally, too fast and so cannot pump blood around the body efficiently. 

Symptoms that could be caused by AF include: 

 - Heart palpitations

 - Chest pain or discomfort

 - Shortness of breath

 - Dizziness and fainting. 

Severe symptoms can be life-threatening and require immediate treatment. However, many people with AF - perhaps as many as a third - don't have any symptoms.

People with AF have a higher risk of having a stroke because the blood can become stagnant and form blood clots. 

The aim of treatment is to prevent complications, particularly stroke, and improve symptoms.

The draft guideline produced by NICE addresses several clinical areas where new evidence has become available since the original guideline was published in 2006. 

 - Offer anticoagulation to people with a CHA2DS2-VASc score of 2 or above, taking bleeding risk into account

 - Assess and offer rate control as the first-line strategy to all people with atrial fibrillation

 - Refer people promptly at any stage if treatment fails to control the symptoms of atrial fibrillation and referral for more specialised management is needed

Professor Mark Baker, director of the centre for clinical practice at NICE, said: “The stark truth is that people with AF have a possible five-fold increased risk of stroke. Therefore it's important that people with AF are diagnosed properly and have their condition managed effectively in order to reduce the significant risk of stroke and prevent deterioration in their quality of life. 

“This updated draft guideline reflects important new evidence about the best ways to treat the condition, including the use of the new generation of oral anticoagulants and ablation strategies, as well as the use of risk calculators to guide treatment decisions. We now look forward to hearing the views of registered stakeholders in order to aid the development of this guideline update.”

The draft guidance is available to view on the NICE website