Atrial fibrillation | March 22, 2023 | FREE
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AHA issues scientific statement on managing atrial fibrillation during hospitalization

Acute manifestations of atrial fibrillation warrant clinical attention during hospitalization, at transitions of care, and over the long term, said the American Heart Association (AHA) statement, which reviewed triggers and treatments for the condition.

The American Heart Association recently issued a scientific statement on atrial fibrillation (AF) during acute hospitalization.

The statement, written for a multidisciplinary audience including hospitalists, expands on existing guidelines by reviewing knowledge and management considerations related to AF that acutely manifests in the setting of acute care or acute illness, including during hospitalization. It was published by Circulation on March 13.

The statement notes that acute AF carries high risk of recurrence and thus warrants clinical attention during acute hospitalization, at transitions of care, and over the long term. A framework of substrates and triggers can be useful for AF evaluation and management, it said. Triggers for acute AF include inflammation, local mechanical stress, oxidative stress, electrolyte imbalance, and shifts in autonomic tone. Potential sources of these triggers include infection, pericardial effusion and inflammation, procedure time, hemodynamic shifts, volume loss or overload, pulmonary complications of surgery, and medications, including inotropic agents.

The statement discusses detection of AF and considerations for inpatient monitoring, noting that patients at higher risk may benefit from electrocardiographic monitoring during hospitalization and that, of the available risk scores, CHA2DS2-VASc has been studied the most extensively for prediction of AF. Management of acute AF should address substrates and triggers and cover the 3A's: Acute triggers, AF rate/rhythm management, and Anticoagulation. The statement notes that the use of acute rate or rhythm control should be individualized. Anticoagulation should be based on the substrate of AF, with consideration of bleeding risk and the patient's acute conditions. The statement discusses management considerations in specific situations, including the ED, the ICU, COVID-19, hypothyroidism, stroke, and surgery.

Finally, the statement advises on long-term management of AF, noting that clinical follow-up and extended heart rhythm monitoring are warranted to determine long-term management and that patients with acute AF benefit from close interdisciplinary care collaborations. Long-term management is described by two of the three A's—AF rate/rhythm management and Anticoagulation—and the two Ms: Monitoring of heart rhythm and Modification of lifestyle and risk factors.