Guidelines for the clinical management of atrial fibrillation: a practical perspective.
OBJECTIVE
Since the management of atrial fibrillation may be difficult in the individual patient, our purpose was to develop simple clinical recommendations to help the general internist manage this common clinical problem.


METHODS
Systematic review of the literature with evaluation of data-related evidence and framing of graded recommendations.


RESULTS
Atrial fibrillation affects some 1% of the population in Western countries and is linked to a significant increase in morbidity and mortality. The management of atrial fibrillation requires individualised evaluation of the risks and benefits of therapeutic modalities, relying whenever possible on simple and validated tools. The two main points requiring a decision in clinical management are 1) whether or not to implement thromboembolic prevention therapy, and 2) whether preference should be given to a "rate control" or "rhythm control" strategy. Thromboembolic prophylaxis should be prescribed after individualised risk assessment: for patients at risk, oral anticoagulation with warfarin decreases the rate of embolic complications by 60% and aspirin by 20%, at the expense of an increased incidence of haemorrhagic complications. "Rate control" and "rhythm control" strategies are probably equivalent, and the choice should also be made on an individualised basis. To assist the physician in making his choices for the care of an atrial fibrillation patient we propose specific tables and algorithms, with graded recommendations.


CONCLUSIONS
On the evidence of data from the literature we propose simple algorithms and tables for the clinical management of atrial fibrillation in the individual patient.
Fumeaux
Thierry
T
Department of Internal Medicine, University Hospital, Geneva, Switzerland.
Cornuz
Jacques
J
Polikar
Ralf
R
Blanc
Edouard
E
Junod
Alain
A
Kappenberger
Lukas
L
Nicod
Pascal
P
Schläpfer
Jürg
J
D000465:Algorithms; D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000188:drug therapy / Q000503:physiopathology / Q000628:therapy*; D004554:Electric Countershock; D006801:Humans; D017410:Practice Guidelines as Topic
D000889:Anti-Arrhythmia Agents; D000925:Anticoagulants