Top 10 Takeaways

Top 10 Takeaways from the 2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation, as referenced in the article “Treat growing epidemic of atrial fibrillation by targeting risk factors, leading cardiologists urge”.

Read the Guidelines

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1. Control and manage risk factors that lead to atrial fibrillation. AF is not an isolated heart rhythm disorder. Clinicians need to take a more holistic approach and consider AF as the symptom of more complex cardiovascular disease. Among risk factors for AF: high blood pressure, diabetes, obesity, sleep apnea, tobacco addiction, and excessive alcohol consumption.
2. Improve diagnosis of atrial fibrillation by screening all patients aged 65 and over during routine medical visits. Screening for AF at these medical visits can be done through pulse palpitations, use of a stethoscope, and point-of-care ECG devices.
3. Reduce the risk of stroke with effective antithrombotic drugs. Use the CCS Algorithm (“CHADS-65”) to identify individuals who should be prescribed blood thinners to prevent stroke. More than 62,000 Canadians a year experience a stroke and those caused by AF tend to be the biggest, most severe, and most debilitating. Stroke prevention is a cornerstone of AF management.
4. Learn new advances in the treatment of complex patients. Many people with AF are also living with coronary artery disease, chronic kidney or liver diseases, obesity, and more. The new guidelines include focused information on prescribing and adjusting anticoagulation for these complex cases.
5. Discover the significant advances made in how to return patients to normal heart rhythm through pharmacological or electrical cardioversion therapy, antiarrhythmic drugs, and catheter ablation. Early in the disease process, returning patients to normal rhythm reduces bad outcomes, including strokes, hospitalizations, and death. New guidelines describe who should receive what kind of therapy and when.
6. Recommend catheter ablation therapy as a frontline treatment to relieve symptoms in eligible patients by eliminating the triggers for AF. The technology used to perform this procedure has evolved substantially in the past decade, allowing for a safe procedure and good outcomes.
7. Treat patients in integrated, multidisciplinary AF clinics that are focused on the whole person and the management of their risk factors. These clinics involve physicians, pharmacists, nurses, dietitians, exercise physiologists and others.
8. Learn new ways to prevent bleeding risk and probe how to manage medication interruptions. One example: Discontinue the routine use of aspirin for stroke prevention in people under the age of 65 with no other risk factors and no vascular disease.
9. Ensure patients who have experienced secondary AF are followed for an indefinite period because the condition may reoccur. Atrial fibrillation can evolve and worsen over time. In the beginning, it may be episodic and then become persistent, and then worsen – scarring the heart, changing its structure, and leading to a permanent rhythm disorder.
10. Use and share CCS/CHRS Knowledge Translation tools available at ccs.ca and bookmark the searchable published guidelines in the Canadian Journal of Cardiology and the Top 10 Takeaways in the Canadian Pharmacists Journal. Join CCS and sign up for updates at guidelines@ccs.ca.