#JustReleased: 2019 AHA/ACC/HRS Guideline Update for Atrial
The 2019 focused update on Atrial Fibrillation has been recently published in the Journal of the American College of Cardiology. This guideline is a collaboration of the ACC and AHA with the Heart Rhythm Society (HRS) and the Society of Thoracic Surgeons.

The present guidance updates the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation”. The areas of the 2014 AF Guideline that were updated were limited to those for which important new data from clinical trials had emerged and/or new U.S. Food and Drug Administration (FDA) indications for thromboembolism protection devices.

The following are key points from the focused update:-

1. Edoxaban has been added to the list of nonvitamin K oral anticoagulants (NOACs [apixaban, dabigatran, and rivaroxaban]) that can be used for stroke prevention

2. NOACs are recommended over warfarin except in patients with moderate to severe mitral stenosis or a prosthetic heart valve

3. The decision to use an anticoagulant should not be influenced by whether the AF is paroxysmal or persistent

4. Renal and hepatic function should be tested before initiation of a NOAC and at least annually thereafter

5. In AF patients with a CHA2DS2-VASc score ≥2 in men or ≥3 in women and a creatinine clearance <15 ml/min or who are on dialysis, it is reasonable to use warfarin or apixaban for oral anticoagulation

6. Idarucizumab is recommended for the reversal of dabigatran in the event of a life-threatening bleed or urgent procedure

7. Andexanet alfa (recombinant factor Xa) can be useful for the reversal of rivaroxaban and apixaban in the event of life-threatening bleeding

8. Percutaneous left atrial appendage occlusion may be considered for at-risk AF patients with AF at increased risk of stroke who have contraindications to long-term anticoagulation

9. AF catheter ablation may be reasonable in symptomatic patients with heart failure and a reduced ejection fraction to reduce mortality and heart failure hospitalizations

10. In at-risk AF patients who have undergone coronary artery stenting, double therapy with clopidogrel and low-dose rivaroxaban (15 mg daily) or dabigatran

11. Weight loss combined with risk factor modification is recommended for overweight and obese patients with AF

12. In patients with cryptogenic stroke in whom external ambulatory monitoring is inconclusive, implantation of a cardiac monitor is reasonable for detection of subclinical AF

About ACC/AHA/HRS
The American College of Cardiology (ACC) is a 52,000-member medical society that is the professional home for the entire cardiovascular care team. The mission of the College is to transform cardiovascular care and to improve heart health. The American Heart Association (AHA) is a non-profit organization in the United States that fosters appropriate cardiac care in an effort to reduce disability and deaths caused by cardiovascular disease and stroke. The Heart Rhythm Society (HRS) is an international non-profit organization that promotes education and advocacy for cardiac arrhythmia professionals and patients.


Note: This list is a brief compilation of some of the key recommendations included in the Guideline and is not exhaustive and does not constitute medical advice. Kindly refer to the original publication here: https://pxmd.co/noulR
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