[The practice guideline 'atrial fibrillation' from the Dutch College of General Practitioners; a response from the perspective of cardiology].
Stroke is the most important complication of atrial fibrillation. The new practice guideline 'Atrial fibrillation' from the Dutch College of General Practitioners strongly advocates active detection of atrial fibrillation and antithrombotic treatment guided by stroke-risk stratification in order to decrease the risk of stroke. The stratification scheme it proposes skips age as a parameter. Instead, the general practitioners propose exclusive use of clinical risk factors such as previous stroke, hypertension, heart failure, coronary artery disease and diabetes. The practice guideline advocates abandoning rhythm control unless the patient is symptomatic and physically fit. The guideline also advocates referral to a cardiologist of a physically fit patient who is younger than the arbitrary age of 65 years. In summary, the new guideline is timely and appears after many new studies have provided important evidence for the optimal diagnosis and treatment of this frequent type of arrhythmia. This guideline will contribute significantly, not only to the improvement of daily clinical practice but also to scientific research. Both electrocardiography and echocardiography can be expected to play a larger role in the future in the patient with atrial fibrillation who is first seen by the general practitioner.
Crijns
H J G M
HJ
Academisch Ziekenhuis, afd. Cardiologie, Maastricht. h.crijns@cardio.azm.nl
D000925:Anticoagulants / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy; D002309:Cardiology / Q000592:standards; D005260:Female; D006801:Humans; D008297:Male; D009426:Netherlands; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D012307:Risk Factors; D020521:Stroke / Q000517:prevention & control
D000925:Anticoagulants