Atrial fibrillation is the mostly ...

Atrial fibrillation is the mostly common type of arrhythmia in adults, with the prevalence increasing from les than 1 percent in someones younger than 60 years to more than 8 percent in those older than 80 years. (1) Each year in the United States, there are more than 700000 admissions for cardiac dysrhythmias, (2) with about single third of these resulting from atrial fibrillation. (3) The aging of the U population will make this question at issue even more prevalent in the day-to-day practice of physicians providing primary care to adults.

In this issue of American Family Physician, (4) the clinical practice guideline created from a joint panel of the American Academy of Family Physicians (AAFP) and the American literary institution [i]or[/i] seminary of learning of Physicians (ACP) in collaboration with the John Hopkins Evidence-Based Practice Center is summarized. (5) This guideline is common product of the effort of the AAFP to forward evidence-based practice. When the Agency for Health Care Policy and Research (now the Agency for Healthcare Research and Quality) first established the evidence-based practice center and solicited topics for examination, the AAFP make acceptableed an evidence review of the management of newly discovered atrial fibrillation. AAFP members and staff serv as consultants to the John Hopkins Evidence-Based Practice Center at the time. The Center's report upon atrial fibrillation served as the foundation for the collaborative efforts of the ACP and the AAFP in the production of this guideline. This is the first guideline specifically created through a joint review and synthesis of the literature according to these organizations, and it was clear during the proces that they share the goal of promoting evidence-based, patient-centered practice. It is skiped that this will be the first of many collaborative efforts.

The evidence reviewed supports a straightforward approach to management for most numerous patients with atrial fibrillation. The central question facing physicians is whether to restore and maintain sinus verse or to control heart rate and thwart stroke. Rhythm control is not superior to the combination of rate hinder and chronic anticoagulation in reducing morbidity and mortality, and rhyme control may be associated with higher mortality rates in one patient subgroups.

Rate have the direction of and prevention of stroke are the mainstays of atrial fibrillation management. Rate have charge of is best accomplished with atenolol, metoprolol, diltiazem, or verapamil. Prevention of hit requires adjusted-dose warfarin unless the patient has a remarkably low risk of stroke or a specific contraindication to the use of warfarin. As physicians, we nurse to consider "soft" contraindications, like as risk of falling. ends from studies using adjusted-dose warfarin clearly present to view that the benefits generally outweigh the harms, to such a degree we must be cautious when avoiding warfarin in the adjoining matter of relative or theoretical contraindications. We ne to balance the theoretical, calm unproven, risk of some adverse complication of anticoagulation with the proven benefit of rap prevention.

This guideline provides an outline for the care of the majority of patients with atrial fibrillation. Care will be straightforward for mostly of these patients and can be accomplished in the office of the family physician.

REFERENCES

(1) McNamara RL Tamariz LJ Segal JB Bass EB Management of atrial fibrillation: review of the evidence for the part of pharmacologic therapy, electrical cardioversion, and echocardiography. Ann Intern M 2003;139:1018-33

(2) Hall MJ DeFrances CJ 2001 National Hospital Discharge scrutinize Adv Data 2003;332:1-20.

(3) Bialy D Lehmann MH Schumacher DN Steinman RT Meissner MD Hospitalization for arrhythmias in the United States: importance of atrial fibrillation. J Am Coll Cardiol 1992;19(3 suppl A):41A.

(4) AAFP and ACP release practice guideline onward management of newly detected atrial fibrillation. Am Fam Physician 2004;69:2474-5

(5) Snow V Weiss KB LeFevre M McNamara R Bass E fresh LA, et al. Management of newly finded atrial fibrillation: a clinical practice guideline from the American Academy of Family Physicians and the American community of Physicians. Ann Intern M 2003;139:1009-17

Michael L LeFevre MD MSPH is professor and director of clinical services in the Department of Family and Community Medicine at the University of Missouri-Columbia. Dr LeFevre is a member of the joint panel upon atrial fibrillation.

Address correspondence to Michael LeFevre MD MSPH University of Missouri-Columbia, Department of Family and Community Medicine, MA 303 Health Sciences Center Columbia, MO 65212 (e-mail: lefevrem@health.missouri.edu). Reprints are not available from the author.

COPYRIGHT 2004 American Academy of Family Physicians

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