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New European guidelines on atrial fibrillation

BMJ 2011; 342 doi: (Published 21 February 2011) Cite this as: BMJ 2011;342:d897
  1. Ross J Hunter, research fellow and registrar,
  2. Richard J Schilling, professor of cardiology
  1. 1Cardiology Research Department, Barts and the London NHS Trust and QMUL, St Bartholomew’s Hospital, London EC1A 7BE, UK
  1. r.schilling{at}

Recommend key changes to management

The European Society of Cardiology (ESC) has recently published guidelines for the management of atrial fibrillation.1 Key changes include the identification of more patients at risk of stroke and wider use of oral anticoagulants, a more pragmatic approach to rate control, and a lower threshold for catheter ablation of atrial fibrillation. The priorities in the management of atrial fibrillation (in order of their effect on prognosis) remain as stroke prevention, rate control, and rhythm control.

Arno Massee/SPL

Stroke prevention

To incorporate new evidence for the role of oral anticoagulants, the simple and easily remembered CHADS2 scoring system has been modified. The age limit for stroke prevention has been lowered to 65, with an additional point in the scoring system given to those 75 years or more.2 An additional point is also now given for women and those with vascular disease. Table 1 summarises the modified (CHA2DS2-VASc) system.

View this table:
Table 1

Stroke risk assessment using the CHA2DS2-VASc system

Other changes are that no treatment is now recommended for a score of zero and oral anticoagulants are recommended over aspirin for a score of 1. Table 2 shows the preferred anticoagulation strategy by CHA2DS2-VASc score. This revised strategy is the result of consistent evidence of the superiority of oral anticoagulants …

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