ATRIAL FIBRILLATION GUIDELINES UPDATED

Atrial fibrillation affects more than 2 millionAmericans. A recent update of guidelines publishedin 2001 provides evidence-based recommendationsand algorithms for managingdifferent types of atrial fibrillation (AF). The keypoints regarding drug therapy are:

1. Heart rate control may be best for olderpatients with hypertension or heart disease,whereas younger patients, particularlythose with paroxysmal lone AF, maybenefit from heart rhythm control.

2. Decisions about anticoagulation therapyshould be based on the patient's strokerisk, rather than on whether sinusrhythm is maintained.

3. The basic recommendations for antithrombotictherapy in AF are aspirin forpatients without stroke risk factors,aspirin or warfarin for patients with 1moderate risk factor, and warfarin forpatients with any high risk factor or morethan 1 moderate risk factor.

High risk factors for stroke include previousstroke, transient ischemic attack, or embolism;mitral stenosis; and a prosthetic heart valve.Moderate risk factors include age >75 years,hypertension, heart failure, ejection fraction<35%, and diabetes.

Dr. Garrett is a clinical pharmacistpractitioner at Cornerstone Health Carein High Point, NC.