NICE updates guidelines on atrial fibrillation based on new evidence

pharmafile | April 27, 2021 | News story | Manufacturing and Production NICE 

NICE has updated its guideline on the diagnosis and management of atrial fibrillation (AF) based on new evidence found since publication of the previous guideline in 2014.

This new evidence includes bleeding risk calculation, the role of newer anti-clotting agents (anticoagulants), and ablation (interventions that aim to destroy or isolate the abnormal sources of electrical impulses in the heart that may be driving AF).

In the guideline published today, it states that evidence shows that ORBIT is the most accurate tool for predicting absolute bleeding risk in people with AF. However, the guideline acknowledges that other bleeding risk tools, including HAS-BLED which NICE’s previous guideline recommended, may need to be used until ORBIT is embedded in clinical pathways and electronic systems.

Anticoagulation was also recommended, with a direct-acting oral anticoagulant being offered to people with atrial fibrillation and a high risk of stroke (CHA2DS2-VASc score of 2 or above), taking into account the risk of bleeding.

When drug treatment is unsuccessful, unsuitable or not tolerated in people with symptomatic intermittent or persistent atrial fibrillation, the updated guideline says radiofrequency point-by-point ablation should be considered or, if this isn’t suitable, either cryoballoon ablation or laser balloon ablation.

AF is the most common heart rhythm disorder, affecting approximately 2% of the adult population, and estimates suggest its prevalence is increasing. AF causes palpitations and breathlessness in many people but it may also be silent and undetected.

If left untreated it is a significant risk factor for stroke and other morbidities and it is estimated that it is responsible for approximately 20% of all strokes and is associated with increased mortality. Men are more commonly affected than women and the prevalence increases with age and in underlying heart disease, diabetes, obesity and hypertension.

Kat Jenkins

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