National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018

Brieger, David; Amerena, John; Attia, John; Bajorek, Beata; Chan, Kim H.; Connell, Cia; Freedman, Ben; Ferguson, Caleb; Hall, Tanya; Haqqani, Haris M.; Hendriks, Jeroen; Hespe, Charlotte; Hung, Joseph; Kalman, Jonathan M.; Sanders, Prashanthan; Worthington, John; Yan, Tristan D.; Zwar, Nicholas

doi:10.1016/j.hlc.2018.06.1043

Cited by 231 publications

(218 citation statements)

References 416 publications

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“…Warfarin was the main oral anticoagulant available during our study period, but adequate monitoring of patients’ international normalised ratio (INR) in rural and remote communities is difficult because of remoteness, limitations in service availability and culturally appropriate referral pathways, and family caring responsibilities. Recent Australian guidelines recommend novel oral anticoagulants (NOACs) for Aboriginal people with non‐valvular AF because they overcome many of the logistic and clinical barriers associated with warfarin . The higher incidence of haemorrhagic stroke in Aboriginal adults under 60 also indicates that NOACs may be safer options than warfarin, although factors such as poor blood pressure control must be taken into account.…”

Section: Discussionmentioning

confidence: 99%

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

Nedkoff

Kelty

Hung

et al. 2020

Medical Journal of Australia

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Objectives To assess the risks of stroke and cardiovascular mortality for Aboriginal and non‐Aboriginal Australians with atrial fibrillation. Design Retrospective data linkage cohort study. Setting, participants All people aged 20–84 years hospitalised with atrial fibrillation in Western Australia during 2000–2012. Main outcome measures Stroke incidence rates and mortality after hospitalisation for atrial fibrillation, and 10‐year risks of stroke and of cardiovascular and all‐cause mortality. Results Among 55 482 index admissions with atrial fibrillation, 7.7% of 20–59‐year‐old patients and 1.3% of 60–84‐year‐old patients were Aboriginal Australians. A larger proportion of Aboriginal patients aged 20–59 years had CHA2DS2‐VASc scores of 2 or more (59.8% v 21.8%). In 20–59‐year‐old Aboriginal patients, the incidence during follow‐up (maximum, 10 years; median, 7.1 years) of stroke (incidence rate ratio [IRR], 3.2; 95% CI, 2.5–4.1) and fatal stroke (IRR, 5.7; 95% CI, 3.9–8.9) were markedly higher than for non‐Aboriginal patients. Stroke incidence was higher for 60–84‐year‐old patients, but the difference between Aboriginal and non‐Aboriginal patients was smaller (IRR, 1.6; 95% CI, 1.3–2.0). Cardiovascular mortality during follow‐up was also higher for 20–59‐year‐old Aboriginal patients (IRR, 4.4; 95% CI, 4.3–5.9). The hazards of stroke (adjusted HR [aHR], 1.67; 95% CI, 1.22–2.28) and cardiovascular mortality (aHR, 1.47; 95% CI, 1.18–1.83) in younger Aboriginal patients remained significantly higher after multivariable adjustment; age/sex, principal diagnosis of atrial fibrillation, and CHA2DS2‐VASc score were the most influential factors. Conclusion Stroke risk and cardiovascular mortality are markedly higher for Aboriginal than non‐Aboriginal patients with atrial fibrillation, particularly for patients under 60. Strategies for providing evidence‐based therapies and cardiovascular prevention to Aboriginal people with atrial fibrillation must be improved.

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Section: Discussionmentioning

confidence: 99%

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

Nedkoff

Kelty

Hung

et al. 2020

Medical Journal of Australia

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“…Box 3 – Long term rhythm control strategies AAD = antiarrhythmic drugs; AF = atrial fibrillation; AV = atrioventricular; CAD = coronary artery disease; CI = contraindications; DHP = dihydropyridine; LV = left ventricular; LVEF = left ventricular ejection fraction. * See Table 2 in the full guidelines 3 for factors favouring rhythm control strategy. † With AV nodal blocking agent.…”

Section: Key Evidence‐based Recommendationsmentioning

confidence: 99%

“…This executive summary provides important recommendations together with their strength of evidence and guidance for their implementation in clinical practice (practice points). The full clinical guidelines are available in Heart, Lung and Circulation at https://protect-au.mimecast.com/s/WwT2CGvm3nhKBOps7l8Wo?domain=doi.org 3 …”

mentioning

confidence: 99%

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018

Brieger

Amerena

Attia

et al. 2018

Medical Journal of Australia

Self Cite

110

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Introduction: Atrial fibrillation (AF) is increasing in prevalence and is associated with significant morbidity and mortality. The optimal diagnostic and treatment strategies for AF are continually evolving and care for patients requires confidence in integrating these new developments into practice. These clinical practice guidelines will assist Australian practitioners in the diagnosis and management of adult patients with AF. Main recommendations: These guidelines provide advice on the standardised assessment and management of patients with atrial fibrillation regarding: screening, prevention and diagnostic work‐up; acute and chronic arrhythmia management with antiarrhythmic therapy and percutaneous and surgical ablative therapies; stroke prevention and optimal use of anticoagulants; and integrated multidisciplinary care. Changes in management as a result of the guideline: Opportunistic screening in the clinic or community is recommended for patients over 65 years of age. The importance of deciding between a rate and rhythm control strategy at the time of diagnosis and periodically thereafter is highlighted. β‐Blockers or non‐dihydropyridine calcium channel antagonists remain the first line choice for acute and chronic rate control. Cardioversion remains first line choice for acute rhythm control when clinically indicated. Flecainide is preferable to amiodarone for acute and chronic rhythm control. Failure of rate or rhythm control should prompt consideration of percutaneous or surgical ablation. The sexless CHA2DS2‐VA score is recommended to assess stroke risk, which standardises thresholds across men and women; anticoagulation is not recommended for a score of 0, and is recommended for a score of ≥ 2. If anticoagulation is indicated, non‐vitamin K oral anticoagulants are recommended in preference to warfarin. An integrated care approach should be adopted, delivered by multidisciplinary teams, including patient education and the use of eHealth tools and resources where available. Regular monitoring and feedback of risk factor control, treatment adherence and persistence should occur.

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“…A summary of recommendations from Australian as well as several international guidelines is outlined in BOX 1 [31, 34–38]. …”

Section: Modifying Cardiovascular Risk In T2dmmentioning

confidence: 99%

“…Cardiac—ECG, longer term monitoring or opportunistic screening may be needed if a patient is > 65 years or has a detectable dysrhythmia or is symptomatic [38]…”

Section: Modifying Cardiovascular Risk In T2dmmentioning

confidence: 99%

Managing Cardiovascular Risk in Type 2 Diabetes: What Do the Cardiovascular Outcome Trials Mean for Australian Practice?

et al. 2019

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Understanding the implications of cardiovascular (CV) outcomes data of glucose-lowering agents on the management of type 2 diabetes mellitus can be challenging for many primary practitioners. Amongst different classes of diabetes medications assessed for CV safety, several agents within the sodium-glucose transport protein-2 inhibitor and glucagon-like peptide-1 receptor agonists classes have demonstrated CV risk reduction. Applying the trial findings to patients typically seen in clinical practice, such as those with established CV disease and those with multiple CV risk factors without established CV disease, requires further clarity. To bridge this gap in our current knowledge, the aim of this review was to utilise expert-driven opinions on common case scenarios and practical recommendations on the most appropriate choice of agents, according to an individual patient’s clinical risk profile (CV and kidney disease), treatment preference and reimbursement environment from an Australian perspective.Funding: Boehringer Ingelheim Australia.

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National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018

Cited by 231 publications

References 416 publications

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

Differences in stroke risk and cardiovascular mortality for Aboriginal and other Australian patients with atrial fibrillation

National Heart Foundation of Australia and Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018

Managing Cardiovascular Risk in Type 2 Diabetes: What Do the Cardiovascular Outcome Trials Mean for Australian Practice?

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