Episode 284: 283. New Guidelines from American College of Cardiology on Atrial Fibrillation

However, screening is not recommended because it has not been shown to improve patient outcomes.. 

Lifestyle recommendations include moderating alcohol use, quitting smoking, exercising, and losing weight if obese. Good news: Coffee need not be restricted.

The authors recommend using a risk score such as CHADS2-VASC to determine the patient’s risk of stroke; if the annual risk of stroke is between 1% and 2% anticoagulation should be considered, and if the annual risk of stroke is greater than 2% then anticoagulation is strongly recommended.

For patients who are low risk (< 1%) — for example, younger than 65 years and without any risk factors for stroke — anticoagulation is not recommended. The guidelines also do not recommend aspirin or aspirin plus clopidogrel for these patients unless there is another indication, such as coronary heart disease. 

 With regard to the choice of anticoagulant, a standard dose of a direct oral anticoagulant (DOAC) is recommended over vitamin K antagonists like warfarin. The exceptions are patients who those with moderate to several mitral stenosis, and those with a mechanical heart valve.