Clinical Practice Guideline

Atrial Fibrillation

Pharmacologic Management of Newly Detected Atrial Fibrillation

(Developed by the AAFP, April 2017)

The guideline, Pharmacologic Management of Newly Detected Atrial Fibrillation was developed by the American Academy of Family Physicians. It was approved by the Board of Directors in April 2017.

Key Recommendations

Rate control is recommended in preference to rhythm control for the majority of patients who have atrial fibrillation. Preferred options for rate control therapy include non-dihydropyridine calcium channel blockers and beta blockers.
Rhythm control may be considered for certain patients based on patient symptoms, exercise tolerance, and patient preferences.
Lenient rate control (<110 beats per minute resting) is recommended over strict rate control (<80 beats per minute resting) for patients who have atrial fibrillation.
The risk of stroke and bleeding should be discussed with all patients considering anticoagulation. The continuous CHADS₂ or continuous CHA₂DS₂-VASc should be considered for prediction of risk of stroke and the HAS-BLED should be considered for prediction of risk for bleeding in patients who have atrial fibrillation.
Chronic anticoagulation is recommended for patients who have atrial fibrillation unless they are at low risk of stroke (CHADS₂<2) or have specific contraindications (strong recommendation, high quality evidence). Choice of anticoagulation therapy should be based on patient preferences and patient history. Options for anticoagulation therapy may include warfarin, apixaban, dabigatran, edoxaban, or rivaroxaban.
Dual treatment with anticoagulant and antiplatelet therapy is not recommended in most patients who have atrial fibrillation.

See the full recommendation for further details.

More About Practice Guidelines

These recommendations are provided only as assistance for physicians making clinical decisions regarding the care of their patients. As such, they cannot substitute for the individual judgment brought to each clinical situation by the patient's family physician. As with all clinical reference resources, they reflect the best understanding of the science of medicine at the time of publication, but they should be used with the clear understanding that continued research may result in new knowledge and recommendations. These recommendations are only one element in the complex process of improving the health of America. To be effective, the recommendations must be implemented.