European Society of Cardiology updates AF treatment Guidelines–Six major focus points

theheart.org: Aug 26, 2012

The treatment of atrial fibrillation is a fast-moving field. It’s a good thing, because the prevalence of the disease continues to increase. In Europe, estimates are that AF burdens almost 2% of the general population. In the past two years, enough data have come available to warrant an update to the 2010 European treatment guidelines.

Here are summaries of six important focus points of this 2012 European update:

Use CHA₂DS₂-VASc rather than CHADS₂ to predict stroke:

In contrast to the North American guidelines, which give preference to the simplerCHADS₂ score, Euro guidelines continue to emphasize the CHA₂DS₂-VASc score (congestive heart failure/left ventricular dysfunction, hypertension, age ≥75 [doubled], diabetes, stroke [doubled]–-vascular disease, age 65–74, and sex category) as the best means to predict stroke. CHA₂DS₂-VASc has two major benefits: It more accurately identifies true low-risk patients, which decreases the risk of over-treating. As important, it reclassifies many CHADS₂-zero patients to a higher risk, which reduces the chances of undertreating. Guideline writer Dr Gregory Lip reminded us that stroke risk in a patient with CHADS₂ score of zero ranges from as low as 0.8% to more than 5%. Speaking in a pro-con debate on post-AF ablation anticoagulation, he was clear about his feelings: “The CHADS₂ score is useless. You might as well toss a coin.” Read more