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British Journal of General Practice

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Clinical Practice

Atrial fibrillation: NICE 2021 update and the focus on anticoagulation

Nicholas R Jones, Thomas Round and Kim Rajappan
British Journal of General Practice 2022; 72 (717): 193-195. DOI: https://doi.org/10.3399/bjgp22X719069
Nicholas R Jones
Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford; Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford.
Roles: GP cardiologist, and Wellcome Trust doctoral research fellow
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Thomas Round
School of Population Health and Environmental Sciences, King’s College London, London; National Cancer Registration and Analysis Service, Public Health England, London.
Roles: GP and National Institute for Health Research doctoral research fellow
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Kim Rajappan
Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals NHS Foundation Trust, Oxford.
Roles: Consultant cardiologist and electrophysiologist
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INTRODUCTION

The National Institute for Health and Care Excellence (NICE) released an updated atrial fibrillation (AF) guideline in April 2021.1 This article provides an overview of the key changes relevant to primary care, which are also covered in RCGP Essential Knowledge Updates (EKU) e-learning. It focuses on stroke and bleeding risk assessment, choice of anticoagulation, and advice on remote monitoring and AF detection.

ATRIAL FIBRILLATION DIAGNOSIS

Diagnosis of AF can be challenging as patients may be asymptomatic or have intermittent or non-specific symptoms and signs. For example, less than half of people with AF have palpitations. This may be of particular concern during the COVID-19 pandemic, with less opportunistic detection of AF and altered patterns of patients accessing health care. A Danish registry study reported a 47% decrease in the incidence of newly diagnosed AF between the first 3 months of 2020 compared with 2019.2

Although the sensitivity of manual pulse palpation to exclude permanent AF is good (93–100%), the positive predictive value of an irregular pulse is between 8–23%.3 The value of opportunistic screening for AF via pulse palpation is also uncertain, even among high-risk populations.4

The emphasis remains on using a 12-lead electrocardiogram (ECG) to diagnose AF. However, patients with intermittent symptoms may need ambulatory monitoring to detect paroxysmal AF. A variety of monitors are now available, including the more traditional external Holter-type devices, newer ‘patch’ monitors that can record for up to 2 weeks while allowing all activities of daily living with the device on, or event recorders, which are patient activated. Feasibility studies suggest many patients might be able to fit ambulatory monitors themselves at home and prefer to do so. This could enable more remote assessment, which may be particularly helpful during the COVID-19 pandemic or in patients with poor mobility. The …

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British Journal of General Practice: 72 (717)
British Journal of General Practice
Vol. 72, Issue 717
April 2022
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Atrial fibrillation: NICE 2021 update and the focus on anticoagulation
Nicholas R Jones, Thomas Round, Kim Rajappan
British Journal of General Practice 2022; 72 (717): 193-195. DOI: 10.3399/bjgp22X719069

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Atrial fibrillation: NICE 2021 update and the focus on anticoagulation
Nicholas R Jones, Thomas Round, Kim Rajappan
British Journal of General Practice 2022; 72 (717): 193-195. DOI: 10.3399/bjgp22X719069
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  • Article
    • INTRODUCTION
    • ATRIAL FIBRILLATION DIAGNOSIS
    • STROKE AND BLEEDING RISK SCORES
    • CHOICE OF ANTICOAGULANT
    • RATE VERSUS RHYTHM CONTROL
    • ABC APPROACH
    • CONCLUSIONS
    • Notes
    • REFERENCES
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More in this TOC Section

  • Relative energy deficiency in sport (RED-S)
  • NICE chronic primary pain guidelines: what the busy GP needs to know
  • Realising the potential of home blood pressure monitoring in the community: should HBPM be the default?
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Print ISSN: 0960-1643
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