Organization/topic	Key recommendations
AACP: antithrombotic therapy for atrial fibrillation35	Use risk scores when deciding on therapy to prevent stroke; direct oral anticoagulants are generally preferred over warfarin or aspirin with or without clopidogrel. Use the CHA2DS2 -VASc score to assess the risk of stroke. Men with a score of 0 and women with a score of 1 are at low risk of stroke and do not require anticoagulation. Direct oral anticoagulants are the preferred agents for most patients with newly diagnosed atrial fibrillation, although this decision should be individualized. Do not use aspirin or aspirin plus clopidogrel (Plavix) for antithrombotic prophylaxis for atrial fibrillation. Use the HAS-BLED score to assess bleeding risk; if the score is 3 or higher, look for ways to reduce risk, educate the patient about what to watch for regarding bleeding, and consider following up more closely. For patients currently taking warfarin (Coumadin), consider switching to a direct oral anticoagulant if they are in the international normalized ratio range less than 65% of the time. If patients are also taking aspirin, first make sure they really need it, then use a low dose (75 to 100 mg) and treat with a concomitant proton pump inhibitor.
ADA/EASD: type 2 diabetes mellitus36	Empower patients to manage their diabetes; metformin is first-line therapy, and second-line therapies include GLP-1 receptor antagonists or SGLT-2 inhibitors. These expert consensus recommendations attempt to shift responsibility and decision-making to where it belongs—with the patients. The recommendations suggest making self-management education and support a cornerstone of treatment. Another pillar of this new approach is selecting medication treatment according to which one is most likely to be taken regularly and over time by a particular patient. The third pillar continues to be metformin. If additional control is needed, adding one or more oral hypoglycemics to the metformin regimen is recommended. For patients with known heart disease, additional treatment with a GLP-1 receptor antagonist such as liraglutide (Victoza) or an SGLT-2 inhibitor such as empagliflozin (Jardiance) is recommended. Sulfonylureas and glitazones (also called thiazolidinediones) are less expensive options.
ACP: breast cancer screening37	Use shared decision-making for women 40 to 49 years of age, screen every two years in women 50 to 74 years of age, and stop screening at 75 years of age or when life expectancy is less than 10 years; do not use clinical breast examinations for screening. Citing that the harms of screening (false-positive results, benign biopsies, and overdiagnosis) outweigh the benefits of early diagnosis, the guideline does not recommend routine screening of women 40 to 49 years of age. Instead, physicians should have a discussion with these patients about the benefits and harms of screening. Women 50 to 74 years of age should be offered screening every two years, stopping when life expectancy is less than 10 years. Patients 75 years or older should not be screened. Clinical breast examinations should no longer be used for screening in women who undergo routine mammography.