Atrial Fibrillation Guidelines

CE / CME

Charting a Course for Success: Navigating New Guidelines in Atrial Fibrillation Management and Treatment

Physician Assistants/Physician Associates: 1.00 AAPA Category 1 CME credit

Nurses: 1.00 Nursing contact hour

Pharmacists: 1.00 contact hour (0.1 CEUs)

Physicians: maximum of 1.00 AMA PRA Category 1 Credit

Released: June 26, 2024

Expiration: June 25, 2025

Christopher B. Granger
Christopher B. Granger, MD

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2023 AHA/ACC Guideline Recommendations for Anticoagulation in Patients With Atrial Fibrillation

Listen to this brief audio clip about 2023 guideline recommendations on who should be on anticoagulation.

Let’s return to guidelines recommendations. This slide depicts who should be treated and the recommended choice for anticoagulation.1

Consider anticoagulation if your patient has an annual risk of stroke of ≥2%, as indicated by a validated assessment tool, such as CHA2DS2-VASc score of ≥2 for men or ≥3 for women (Class 1a recommendation). Other risk scores such as ATRIA or GARFIELD can be used as well.

Anticoagulation is reasonable if your patient has an annual risk of stroke of 1% to 2%, as indicated by one of these tools (eg, a score of 1 for men or 2 for women when using CHA2DS2-VASc) (Class 2a recommendation).This is a situation in which adding a biomarker score such as the NT-proBNP might be helpful to determine risk for stroke.

For choice of agent, DOACs are preferred over warfarin except for cases involving rheumatic heart disease, rheumatic mitral stenosis, or mechanical heart valves (Class 1a recommendation). Aspirin is not recommended.

An 85-year-old male patient with long-standing persistent atrial fibrillation presents for his routine international normalized ratio (INR) visit. He has been in therapeutic range 49% of the time over the past 8 months. He has a CHA2DS2-VASc score of 5, a creatinine clearance of 63 mL/min, and no recent history of significant bleeding and reports falling 1-2 times per month. He lives with his daughter and her family.

Which of the following is the best plan for adjusting his anticoagulation regimen today?