2018 Australian Clinical Guidelines for Diagnosis and Management of Atrial Fibrillation.

Guideline available here.  It is a joint guideline of the National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand 

Useful Acute Management Flowcharts:

• Acute Rate Control Management Flowchart (page 1226)
• Electrical Cardioversion Timing & Anticoagulation Flowchart (page 1223)

Other key aspects of guideline pertaining to acute care:

• All newly diagnosed patients with AF require workup including: (page 1222)
  • 12 lead ECG
  • Full blood count, electrolytes (potassium, sodium, calcium and magnesium) and renal function.
  • TSH testing but this should delayed in acutely ill patients until resolution of acute illness. Hence this screening should be reserved for stable outpatients.  (page 1224)
  • Transthoracic Echo (page 1222)
    • Establishes factors that increase stroke risk such as left ventricular dysfunction, increased left atrial size/volume, mitral stenosis and regurgitation
    • Can detect moderate to severe mitral stenosis which results in classification as Valvular AF (see below)
• Use CHA₂DS₂-VA score (the “sexless CHA₂DS₂-VAS_C“) to determine need for anticoagulation (page 1234) and balance against bleeding risk using validated score (e.g. HAS-BLED)
• Valvular AF v non-valvular AF
  • Valvular AF refers to AF in patients with either a mechanical valve or moderate-severe mitral stenosis. Non-valvular AF refers to patients without these conditions. (page 1219)
  • NOACs are recommended in preference to warfarin for anticoagulation of non-valvular AF (page 1237)
  • Warfarin is recommended for valvular AF and NOACS should not be used (page 1237)