160146 - Cardiology Update 5 (in a series of 6) - Atrial Fibrillation

This update has been developed with a GP focus in order to expand the understanding of diagnostic and management strategies for patients presenting with Atrial Fibrillation. A specialist cardiologist will review and examine evidence, patient case studies and the available diagnostic and the treatment options available to General Practitioners.

Atrial fibrillation is a worldwide epidemic associated with significant morbidity and mortality. Non-vitamin K antagonist oral anticoagulants (NOACs) are an alternative for vitamin K antagonists (VKAs) to prevent stroke in patients with AF. NOACs have emerged as the preferred choice, particularly in patients newly started on anticoagulation, due to improved efficacy/safety ratio, a predictable anticoagulant effect without the need for routine monitoring, and fewer food and drug interactions compared with VKAs.6 However, the proper use of NOACs requires a carefully considered approach to many practical aspects. 

Furthermore, despite the efficacy of oral anticoagulation, many patients are not treated due to absolute or perceived contraindications. Percutaneous left atrial appendage closure has emerged as an effective alternative for stroke prevention in patients who are inappropriate for oral anticoagulation.