New Atrial Fibrillation Guideline Focuses on Pharmacologic Management

Thursday, June 1, 2017

Stephanie A. Wilken
American Academy of Family Physicians
(800) 274-2237, Ext. 6053

LEAWOOD, Kan. -- The American Academy of Family Physicians today issued a Clinical Practice Guideline that will help guide clinicians in the pharmacologic management of atrial fibrillation. 

Atrial fibrillation is one of the most common types of arrhythmia in adults worldwide – and the CDC estimates that up to 6.1 million people in the United States are affected. The number of patients seeking treatment for atrial fibrillation is expected to increase with the aging U.S. population, and atrial fibrillation increases the person’s risk for stroke by four to five times compared with stroke risk for people who don’t have atrial fibrillation. This makes management of the condition imperative to public health.

The guideline titled "Pharmacologic Management of Newly Detected Atrial Fibrillation" targets a patient population of adults who have nonvalvular atrial fibrillation that is not due to a reversible cause. This guideline updates and replaces an earlier guideline published in 2003 from the AAFP and the American College of Physicians, which was reaffirmed by the AAFP in 2008.

While other treatments were deemed outside the scope of this guideline, family physicians should be aware of the full range of options and discuss these with their patients. This guideline does not apply to patients who have atrial fibrillation due to a reversible cause (post-operative, post-myocardial infarction, or due to hyperthyroidism) or patients who have atrial fibrillation due to valvular disease.

Recommendations from the guideline include:
• 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.

For more information on this and other AAFP Clinical Practice Guidelines, visit

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Founded in 1947, the American Academy of Family Physicians represents 134,600 physicians and medical students nationwide, and it is the only medical society devoted solely to primary care.

Family physicians conduct approximately one in five of the total medical office visits in the United States per year – more than any other specialty. Family physicians provide comprehensive, evidence-based, and cost-effective care dedicated to improving the health of patients, families and communities. Family medicine’s cornerstone is an ongoing and personal patient-physician relationship where the family physician serves as the hub of each patient’s integrated care team. More Americans depend on family physicians than on any other medical specialty.

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