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Therapy Decided by Risk Factors

sk for stroke,” he said. “About 15 percent to 20 percent of strokes occur in people with AF, and those strokes are especially large and disabling.

“Incorporating existing recommendations on anti-clotting therapy from the stroke primary prevention guidelines will streamline patient care and make recommendations clearer for physicians,” he said.

In the United States and Europe, hospital admissions for AF have increased by 66 percent during the last 20 years. It is also expensive, with total costs approaching €13.5 billion (about U.S. $15.7 billion) in the European Union alone, according to the statement. No figures are available for total U.S. costs.

The revised guidelines also recommend daily aspirin therapy (81–325 mg) to guard against blood clots in AF patients with no stroke risk factors. Aspirin or warfarin is recommended for those with one “moderate” risk factor (over age 75, high blood pressure, heart failure, impaired left ventricular systolic function or diabetes). Warfarin is recommended for people with any “high” risk factor (previous stroke, transient ischemic attack [TIA], systematic embolism or prosthetic heart valve) or more than one moderate risk factor.

According to co-chair Lars E. Rydén, M.D., Ph.D., also a fellow of all associations and professor emeritus at Karolinska Institutet in Stockholm, Sweden, the guidelines help physicians prioritize the objectives of patient care according to the following steps: 1) controlling heart rate, 2) preventing clots, and, if possible, 3) correcting the rhythm disturbance. Rate control usually involves achieving a ventricular rate (pulse) of 60 to 80 beats per minute at rest and between 90 and 115 beats per minute during moderate exercise.

Also new in the guidelines, catheter ablation — a procedure that corrects irregular heartbeat with radiofrequency energy — is considered “a reasonable alternative to drug therapy to treat AF in patients with little or no left a
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