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:

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-VASC“) 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)
    • Wafrain is recommended for valvular AF and NOACS should not be used (page 1237)