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ManageAnticoag App
Tools: ManageAnticoag helps clinicians navigate periprocedural planning and bleed management scenarios for patients on oral anticoagulants (OAC).
Implementing Improvements: Opportunities to Integrate Quality Improvement and Implementation Science
Guidelines/Clinical Documents: In hospitals, improvers and implementers use quality improvement science (QIS) and less frequently implementation research (IR) to improve health care and health outcomes. Narrowly defined quality improvement (QI) guided by QIS focuses on transforming…
2020 Canadian Cardiovascular Society/Canadian Heart Rhythm Society Comprehensive Guidelines for the Management of Atrial Fibrillation (Andrade et al, Can J Cardiol [CJC] 2020 and SUPPL)
Guidelines/Clinical Documents: Guidelines from CCS to inform best practices for clinicians across all disciplines while treating AFib patients. This document should be an important aid for knowledge translation and a tool to help improve clinical management of this important and challenging arrhythmia.
Summary of Evidence-Based Guideline Update: Prevention of Stroke in Nonvalvular Atrial Fibrillation. Report of the Guideline Development Subcommittee of the American Academy of Neurology (Culebras et al, Neurology 2014)
Summary of Evidence-Based Guideline Update: Prevention of Stroke in Nonvalvular Atrial Fibrillation.…
Oral Anticoagulation in Patients With Nonvalvular Atrial Fibrillation and a CHA2DS2-VASc Score of 1
Guidelines/Clinical Documents: Guidelines document outlining best practices for oral anticoagulation in patients with nonvalvular AFib and a CHA2DS2-VASc Score of 1.
European Primary Care Cardiovascular Society (EPCCS) Consensus Guidance on Stroke Prevention in Atrial Fibrillation (SPAF) in Primary Care (Hobbs et al, Eur J Prev Cardiol [EJPC] 2016 and SUPPL)
Background: Atrial fibrillation affects 1–2% of the general population and 10% of those over 75, and is responsible for around a quarter of all strokes. These strokes are largely preventable by the use of anticoagulation therapy, although many eligible patients are not treated. Recent large clinical trials have added to the evidence base on stroke prevention and international clinical guidelines have been updated. Design: Consensus practical recommendations from primary care physicians with an interest in vascular disease and vascular specialists. Methods: A focussed all-day meeting, with presentation of summary evidence under each section of this guidance and review of European guidelines on stroke prevention in atrial fibrillation, was used to generate a draft document, which then underwent three cycles of revision and debate before all panel members agreed with the consensus statements. Results: Six areas were identified that included how to identify patients with atrial fibrillation, how to determine their stroke risk and whether to recommend modification of this risk, and what management options are available, with practical recommendations on maximising benefit and minimising risk if anticoagulation is recommended and the reasons why antiplatelet therapy is no longer recommended. The summary evidence is presented for each area and simple summary recommendations are highlighted, with areas of remaining uncertainty listed. Conclusions: Atrial fibrillation-related stroke is a major public health priority for most health systems. This practical guidance can assist generalist community physicians to translate the large evidence base for this cause of preventable stroke and implement this at a local level.
Updated Clinical Practice Guideline: Pharmacologic Management of Newly Detected Atrial Fibrillation (Frost et al, 2017)
Guidelines/Clinical Documents: To review the evidence and provide clinical recommendations for the pharmacologic management of atrial fibrillation. Methods: This guideline is based on two systematic reviews of published randomized controlled trials (RCTs) and prospective and retrospective observational studies from 2000 to 2012. An updated literature search was performed to identify new studies from 2012 to December 31, 2015. The targeted audience for the guideline includes all primary care clinicians, and the targeted patient population includes adults who have nonvalvular atrial fibrillation that is not due to a reversible cause. This guideline was developed using a modified version of GRADE to evaluate the quality of the evidence and make recommendations based on the balance of benefits and harms.
Society of Thoracic Surgeons 2017 Clinical Practice Guidelines for the Surgical Treatment of Atrial Fibrillation (Badhwar et al, Ann Thorac Surg [ATS] 2017)
Guidelines/Clinical Documents: Surgical ablation for atrial fibrillation (AF) can be performed without additional risk of operative mortality or major morbidity, and is recommended at the time of concomitant mitral operations to restore sinus rhythm. (Class I, Level A) Surgical ablation for AF can be performed without additional operative risk of mortality or major morbidity, and is recommended at the time of concomitant isolated aortic valve replacement, isolated coronary artery bypass graft surgery, and aortic valve replacement plus coronary artery bypass graft operations to restore sinus rhythm. (Class I, Level B nonrandomized) Surgical ablation for symptomatic AF in the absence of structural heart disease that is refractory to class I/III antiarrhythmic drugs or catheter-based therapy or both is reasonable as a primary stand-alone procedure, to restore sinus rhythm. (Class IIA, Level B randomized) Surgical ablation for symptomatic persistent or longstanding persistent AF in the absence of structural heart disease is reasonable, as a stand-alone procedure using the Cox-Maze III/IV lesion set compared with pulmonary vein isolation alone. (Class IIA, Level B nonrandomized) Surgical ablation for symptomatic AF in the setting of left atrial enlargement (‡4.5 cm) or more than moderate mitral regurgitation by pulmonary vein isolation alone is not recommended. (Class III no benefit, Level C expert opinion) It is reasonable to perform left atrial appendage excision or exclusion in conjunction with surgical ablation for AF for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C limited data) At the time of concomitant cardiac operations in patients with AF, it is reasonable to surgically manage the left atrial appendage for longitudinal thromboembolic morbidity prevention. (Class IIA, Level C expert opinion) In the treatment of AF, multidisciplinary heart team assessment, treatment planning, and long-term follow-up can be useful and beneficial to optimize patient outcomes. (Class I, Level C expert opinion)
Guidelines for the Primary Prevention of Stroke: A Statement for Healthcare Professionals From the AHA/ASA
Guidelines/Clinical Documents: Guidelines document outlining best practices for the primary prevention of stroke among individuals who have not previously experienced a stroke or transient ischemic attack.