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 AAFP represents 136,700 physicians and medical students nationwide. It is the largest medical society devoted solely to primary care. Family physicians conduct approximately one in five office visits -- that’s 192 million visits annually or 48 percent more than the next most visited medical specialty. Today, family physicians provide more care for America’s underserved and rural populations than any other medical specialty. Family medicine’s cornerstone is an ongoing, personal patient-physician relationship focused on integrated care.  To learn more about the specialty of family medicine, the AAFP's positions on issues and clinical care, and for downloadable multi-media highlighting family medicine, visit For information about health care, health conditions and wellness, please visit the AAFP’s award-winning consumer website,