The management of atrial fibrillation: summary of updated NICE guidance

Abstract

Atrial fibrillation is increasingly common,1 with more than 800 000 people being affected in England.2 Many people are managed in primary care without hospital involvement. The condition is a major cause of morbidity, particularly stroke, and it reduces life expectancy. Strokes caused by atrial fibrillation are largely avoidable—most can be prevented by anticoagulation. Yet uptake of anticoagulation by people with known atrial fibrillation who are at increased risk of stroke is suboptimal.3 4 5 Since the publication of the 2006 guidance, several developments relating to risk stratification, stroke prevention, and rhythm management have led to a partial update on the 2006 guidance. This article summarises the most recent recommendations from the National Institute for Health and Care Excellence (NICE).6 NICE recommendations are based on systematic reviews of best available evidence and explicit consideration of cost effectiveness. When minimal evidence is available, recommendations are based on the Guideline Development Group’s experience and opinion of what constitutes good practice. Evidence levels for the recommendations are given in italic in square brackets. All recommendations below should be in accordance with the NICE patient experience guideline,7 and the benefits and risks of treatment should be discussed with the patient. ### Diagnosis and assessment