BY TONI LAPP
Family physicians and internists can check out new guidelines on atrial fibrillation. "Management of Newly Detected Atrial Fibrillation" premiered in the Dec. 16 Annals of Internal Medicine. The guidelines are the result of work by the Joint Panel of the AAFP and the American College of Physicians on Atrial Fibrillation.
Atrial fibrillation, the most common type of arrhythmia in adults, can lead to stroke. The new recommendations are based on the evidence-based practice report released in May 2000 by the Agency for Healthcare Research and Quality, and they incorporate important new evidence that has become available since the report was published, said FP Michael LeFevre, M.D., of Columbia, Mo., a co-chair of the panel.
Perhaps the most notable recommendation deals with the fundamental question of whether to attempt rate control or rhythm control. Contrary to common practice, research has not shown rhythm control to be superior to rate control, and rhythm control may be inferior in certain subgroups, the panel found.
"The generally accepted practice has been to do everything we can to get patients back into sinus rhythm and to try to keep them there," said LeFevre. "This guideline asserts that the best approach for most patients with atrial fibrillation is to focus on control of heart rate and stroke prevention, rather than attempt to restore sinus rhythm."
The authors reviewed almost 200 studies to identify the benefits of using blood thinners to prevent stroke, of slowing heart rate versus converting to normal rhythm and of using electrical versus pharmacologic cardioversion to convert to normal rhythm.
Other guideline recommendations address stroke prevention and anticoagulation, electrical cardioversion versus pharmacologic cardioversion, the role of transesophageal echocardiography in guiding therapy, and maintenance therapy.
ACP and AAFP have collaborated previously on a guideline on the prevention and management of migraines, published in the Nov. 19, 2002, Annals of Internal Medicine. Those guidelines were derived from the migraine headache guidelines developed by the Headache Consortium, in which the AAFP was a partner. Two more clinical practice guidelines -- on deep venous thrombosis and pulmonary embolism -- are in the works.
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Copyright © 2004 by
American Academy of Family Physicians.