The 2018 Korean Heart Rhythm Society Guidelines for Integrated Management of Korean patients with Nonvalvular Atrial Fibrillation

Abstract

Atrial fibrillation (AF) is the most common form of sustained arrhythmia in elderly patients. However, AF is often detected during health screening, or accidentally during testing for other diseases; some patients lack clinical symptoms. Nevertheless, AF increases the incidence of ischemic stroke and other thrombotic events, and compromises cardiovascular prognosis in terms of heart failure, dementia, and hospitalization. Therefore, initial AF management should be performed at the point of primary care, not only in specialized medical centers. We wish to propose a five-step management protocol for AF. We review the evidence supporting integrated management by primary care physicians new to AF, and by specialized physicians who often diagnose and manage AF. Further, we also outline a structured goal-based follow-up protocol; this is an important part of integrated management. (Korean J Med 2018;93:336-343)

Outcomes in relation to antithrombotic therapy among patients with atrial fibrillation after percutaneous coronary intervention

“…The higher bleeding risk in patients with OAC groups compared to those with APT only would be accentuated by prolonged prescription of APT in these patients, which is inconsistent with guideline recommendations [ 1 , 2 ]. Since NOAC has been the primary choice for anticoagulation in AF management [ 1 – 3 ], growing evidence has shown the clinical benefit of NOAC-based combination therapy after PCI in AF patients compared with conventional VKA-based triple therapy. Currently, 4 randomized trials with different types of NOAC have been reported: PIORNEER AF-PCI (rivaroxaban) [ 26 ], RE-DUAL PCI (dabigatran) [ 27 ], AUGUSTUS (apixaban) [ 28 ], and ENTRUST-AF PCI (edoxaban) [ 29 ].…”

“…Patients with atrial fibrillation (AF) at moderate to high risk of stroke are recommended for stroke prevention with oral anticoagulants (OAC) and for those who underwent percutaneous coronary intervention (PCI), combination antithrombotic therapy with OAC and antiplatelets (APT) is required [1][2][3]. However, previous studies reported an under-prescription of OAC in patients with AF after PCI, especially among the Asian population [4][5][6][7].…”