2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines

Abstract

AIM The “2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation” provides recommendations to guide clinicians in the treatment of patients with atrial fibrillation. METHODS A comprehensive literature search was conducted from May 12, 2022, to November 3, 2022, encompassing studies, reviews, and other evidence conducted on human subjects that were published in English from PubMed, EMBASE, the Cochrane Library, the Agency for Healthcare Research and Quality, and other selected databases relevant to this guideline. Additional relevant studies, published through November 2022, during the guideline writing process, were also considered by the writing committee and added to the evidence tables, where appropriate. STRUCTURE Atrial fibrillation is the most sustained common arrhythmia, and its incidence and prevalence are increasing in the United States and globally. Recommendations from the “2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” and the “2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation” have been updated with new evidence to guide clinicians. In addition, new recommendations addressing atrial fibrillation and thromboembolic risk assessment, anticoagulation, left atrial appendage occlusion, atrial fibrillation catheter or surgical ablation, and risk factor modification and atrial fibrillation prevention have been developed.

Association between oral anticoagulant adherence and serious clinical outcomes in patients with atrial fibrillation: A long-term retrospective cohort study

“…We were unable to distinguish clinician-guided therapy discontinuations (temporary or permanent) from patient-initiated ones in our calculation of PDC. Considering the life-long nature of thromboprophylaxis in AF patients, the few absolute contraindications to OACs, and consensus guidelines recommending they be resumed even after major bleeding, 63–65 we believe this to have had a minor impact in our estimation of OAC adherence.…”

Atrial Fibrillation Symptom Assessment—It’s Us, We’re (Part of) the Problem

“…The recently updated AF guidelines allow for more nuance and shared decision-making throughout AF care, combined with classic risk score-based decisions. 1 This requires strong patientclinician communication. The KICS-AF analysis by Ikemura et al 2 suggest that clinicians can be inaccurate in assessing patients' treatment-related concerns.…”

“…Care of patients with AF is geared toward several primary objectives: stroke risk assessment and prevention, addressing modifiable risk factors, and symptom management. 1 Each of these is vital to effectively reduce morbidity and mortality related to AF. Importantly, they each require an engaged and productive therapeutic alliance between patient and clinician.…”

Centennial Collection: Health Applications of Digital Technologies

“…The 2023 American College of Cardiology/American Heart Association/American College of Clinical Pharmacy/Heart Rhythm Society Guideline for the Diagnosis and Management of Atrial Fibrillation includes a class IIa recommendation in favor of using consumer-accessible electrocardiographic devices for rhythm monitoring. 2 Digital health is likely to continue shaping cardiovascular guidelines in the years to come.…”