PHILADELPHIA (December 16, 2003) The American Academy of Family Physicians and the American College of Physicians today released joint guidelines to manage new onset atrial fibrillation, a common arrhythmia (irregular heartbeat) that occurs most often in older adults. According to the new guidelines, control of heart rate (not heart rhythm) with chronic anticoagulation medication is the recommended strategy for the majority of patients with atrial fibrillation. The guidelines identify drugs recommended for controlling heart rate during exercise and at rest. The guidelines and the background paper on which they are based are published in the Dec. 16, 2003, issue of Annals of Internal Medicine, published by ACP.

Atrial fibrillation is an abnormal heart rhythm in which the upper heart chambers (atria) contract rapidly, pumping blood inefficiently. The condition is rarely fatal, but, if uncontrolled, can cause stroke when blood clots formed in the atria travel to the brain. Standard treatments have attempted to convert the heart to normal rhythm, either with medications or electricity, and often use long-term medication to try to maintain the normal rhythm.

"The generally accepted practice has been to do everything we can to get patients back into sinus rhythm and to try to keep them there," said Michael LeFevre, MD, MSPH, family physician and co-chair of the Joint AAFP-ACP Panel on Atrial Fibrillation. "The best available research showed that the preferred approach for most patients with atrial fibrillation should be to focus on control of heart rate and stroke prevention with blood thinners, rather than attempt to restore sinus rhythm. Controlling rhythm was not better than controlling rate in reducing complications and death, and the side effects of medications to keep patients in normal rhythm may be greater than their benefits."

"We are proposing that a major goal of treatment should be to control the individual's heart rate and relie
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15-Dec-2003

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