Interpretation of the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

YANG Ziqi , ZHU Zeyu , LUO Qiyu ,  QIAN Yongjun

Department of Cardiovascular Surgery, West China Hospital, Med-X Center for Materials, Sichuan University, Chengdu, 610041, P. R. China;

Corresponding author：

QIAN Yongjun, Email: qianyongjun@scu.edu.cn

Keywords：

Atrial fibrillation; interpretation of guidelines; diagnosis and management

DOI：

10.7507/1007-4848.202402044

Video：

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This article provides an interpretive review of the "2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation", which was updated and published by the American College of Cardiology (ACC), the American Heart Association (AHA), the American College of Chest Physicians (ACCP), and the Heart Rhythm Society (HRS) based on the latest clinical evidence. It delves into the classification and management strategies for atrial fibrillation (AF), grounded in the most current evidence-based medical research. The guideline offers significant updates in various aspects such as the definition and staging of AF, clinical evaluation and treatment, modification of risk factors, prevention of thromboembolism, and management of specific populations. Notably, the introduction of a new staging model for AF and corresponding management strategies stands out, underscoring the importance of prevention and early intervention. This article focuses on the three pillars of integrated AF management—stroke risk assessment, modification of risk factors, and management of specific patient groups, in addition to rate and rhythm control, analyzes their substantial significance in clinical practice and guides clinicians in providing more precise treatment.

Citation： YANG Ziqi, ZHU Zeyu, LUO Qiyu, QIAN Yongjun. Interpretation of the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 654-666. doi: 10.7507/1007-4848.202402044 Copy

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1. Andersen JH, Andreasen L, Olesen MS. Atrial fibrillation—A complex polygenetic disease. Eur J Hum Genet, 2021, 29(7): 1051-1060.
2. Chung MK, Refaat M, Shen WK, et al. Atrial fibrillation: JACC Council perspectives. J Am Coll Cardiol, 2020, 75(14): 1689-1713.
3. Deshmukh A, Iglesias M, Khanna R, et al. Healthcare utilization and costs associated with a diagnosis of incident atrial fibrillation. Heart Rhythm, 2022, 3(5): 577-586.
4. Weng LC, Preis SR, Hulme OL, et al. Genetic predisposition, clinical risk factor burden, and lifetime risk of atrial fibrillation. Circulation, 2018, 137(10): 1027-1038.
5. Du X, Guo L, Xia S, et al. Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China. Heart, 2021, 107(7): 535-541.Du X, Guo L, Xia S, et al. Atrial fibrillation prevalence, awareness and management in a nationwide survey of adults in China. Heart, 2021, 107(7): 535-541.
6. Kirchhof P, Benussi S, Kotecha D, et al. 2016 ESC guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J, 2016, 37(38): 2893-2962.
7. Zhao QY, Shi SB, Huang H, et al. Contemporary characteristics, management, and outcomes of patients hospitalized for atrial fibrillation in China: Results from the real-world study of Chinese atrial fibrillation registry. Chin Med J (Engl), 2020, 133(23): 2883-2884.
8. Shi S, Tang Y, Zhao Q, et al. Prevalence and risk of atrial fibrillation in China: A national cross-sectional epidemiological study. Lancet Reg Health West Pac, 2022, 23: 100439.
9. 周自强, 胡大一, 陈捷, 等. 中国心房颤动现状的流行病学研究. 中华内科杂志, 2004, 43(7): 491-494.
10. Joglar JA, Chung MK, Armbruster AL, et al. 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation. J Am Coll Cardiol, 2024, 83(1): 109-279.
11. Himmelreich JCL, Veelers L, Lucassen WAM, et al. Prediction models for atrial fibrillation applicable in the community: A systematic review and meta-analysis. Europace, 2020, 22(5): 684-694.
12. Haïssaguerre M, Jaïs P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med, 1998, 339(10): 659-666.
13. Howell SJ, Dukes JW, Vittinghoff E, et al. Premature atrial contraction location and atrial fibrillation inducibility. Circ Arrhythm Electrophysiol, 2023, 16(2): e011623.
14. Hindricks G, Potpara T, Dagres N, et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): The Task Force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European Heart Rhythm Association (EHRA) of the ESC. Eur Heart J, 2021, 42(5): 373-498.
15. Guo Y, Lane DA, Wang L, et al. Mobile health technology to improve care for patients with atrial fibrillation. J Am Coll Cardiol, 2020, 75(13): 1523-1534.
16. Takabayashi K, Hamatani Y, Yamashita Y, et al. Incidence of stroke or systemic embolism in paroxysmal versus sustained atrial fibrillation: The Fushimi Atrial Fibrillation Registry. Stroke, 2015, 46(12): 3354-3361.
17. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 aha/acc/hrs guideline for the management of patients with atrial fibrillation: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol, 2019, 74(1): 104-132.
18. January CT, Wann LS, Calkins H, et al. 2019 AHA/ACC/HRS focused update of the 2014 AHA/ACC/HRS guideline for the management of patients with qtrial fibrillation: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice guidelines and the Heart Rhythm Society in collaboration with the Society of Thoracic Surgeons. Circulation, 2019, 140(2): e125-e151.
19. Lip GY, Nieuwlaat R, Pisters R, et al. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: The Euro Heart Survey on atrial fibrillation. Chest, 2010, 137(2): 263-272.
20. Quinn GR, Severdija ON, Chang Y, et al. Wide variation in reported rates of stroke across cohorts of patients with atrial fibrillation. Circulation, 2017, 135(3): 208-219.
21. Singer DE, Chang Y, Borowsky LH, et al. A new risk scheme to predict ischemic stroke and other thromboembolism in atrial fibrillation: The ATRIA Study Stroke Risk Score. J Am Heart Assoc, 2013, 2(3): e000250.
22. Fox KAA, Lucas JE, Pieper KS, et al. Improved risk stratification of patients with atrial fibrillation: An integrated GARFIELD-AF tool for the prediction of mortality, stroke and bleed in patients with and without anticoagulation. BMJ open, 2017, 7(12): e017157.
23. van der Endt VHW, Milders J, Penning de Vries BBL, et al. Comprehensive comparison of stroke risk score performance: A systematic review and meta-analysis among 6 267 728 patients with atrial fibrillation. Europace, 2022, 24(11): 1739-1753.
24. van den Ham HA, Klungel OH, Singer DE, et al. Comparative performance of ATRIA, CHADS2, and CHA2DS2-VASc risk scores predicting stroke in patients with atrial fibrillation: Results from a national primary care database. J Am Coll Cardiol, 2015, 66(17): 1851-1859.
25. Dalgaard F, Pieper K, Verheugt F, et al. GARFIELD-AF model for prediction of stroke and major bleeding in atrial fibrillation: A Danish nationwide validation study. BMJ Open, 2019, 9(11): e033283.
26. Shah SJ, Eckman MH, Aspberg S, et al. Effect of variation in published stroke rates on the net clinical benefit of Anticoagulation for Atrial Fibrillation. Ann Intern Med, 2018, 169(8): 517-527.
27. Go AS, Reynolds K, Yang J, et al. Association of burden of atrial fibrillation with risk of ischemic stroke in adults with paroxysmal atrial fibrillation: The KP-RHYTHM Study. JAMA Cardiol, 2018, 3(7): 601-608.
28. Pisters R, Lane DA, Nieuwlaat R, et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: The Euro Heart Survey. Chest, 2010, 138(5): 1093-1100.
29. Gage BF, Yan Y, Milligan PE, et al. Clinical classification schemes for predicting hemorrhage: Results from the National Registry of Atrial Fibrillation (NRAF). Am Heart J, 2006, 151(3): 713-719.
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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Interpretation of the 2023 ACC/AHA/ACCP/HRS guideline for the diagnosis and management of atrial fibrillation

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