New post on Medscape/Cardiology: My take of the 2014 Atrial Fibrillation treatment guidelines

Atrial fibrillation affects millions of patients, and its incidence and prevalence are on the rise. It’s a peculiar disease in that it affects people so differently. When populations are studied, AF associates with higher rates of stroke, heart failure and death. But patients aren’t populations.

In recent years, the treatment options for this pesky disease have expanded. This is both good news and bad news. The good news is that when these treatments are applied wisely, with an engaged patient, outcomes can be improved. As an AF caregiver, it is gratifying to use these tools to help people. The bad news is that AF treatment can be worse than the disease. The greatest challenge in trying to help patients with AF is to do so without making them worse. AF treatment is not easy. Not even close. The act of treating AF marches both patient and caregiver right up to the edge–of doing harm.

Specialists in atrial fibrillation treat only a small fraction of the millions of patients with AF. Primary care doctors and general cardiologists treat the majority. This is why the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation is so important. The 123-page document lays out the most comprehensive and up-to-date information about the disease. The writing committee had a daunting task. The evidence base for AF is enormous. Getting it into a readable concise document was no small task.

I’m pleased to announce that the writers succeeded. I really liked the new guidelines. The writers mostly avoided telling us what to do. Instead, they wrote concisely and clearly about the evidence. They emphasized patient preferences and shared decisions. They weren’t perfect in removing paternalism but they took a major step forward.

Before heading out on vacation, I read all 123 pages of this document. I jotted down notes and put them together into a post–which was part reporting and part editorial. The post went up today on theHeart.org | Medscape/Cardiology.

I hope you want to read my summary. It’s written for a physician audience so there is some medical speak. I broke it down into ten notable categories, each with 1-2 paragraphs. Big categories got bulleted lists. I concluded with one criticism.

Here is the link and title of my post: 2014 AF Treatment Guidelines: 10 Things to Like and Only One to Dislike

JMM

2 comments

  1. Dr John,

    Electrophysiology is a young specialty. It’s come quite a distance in recent years, but it’s only really just started. You yourself have called ablation a “hammer”.

    These guidelines, and your clear presentation, are excellent – viewed from here-and-now.

    I’m wondering about the more long-term future, presuming there will still be AF even with universal attention to lifestyle. Are we headed in the right direction? Is incremental improvement on the hammer the way to go?

    Something completely different: Dr Avula et al presented the concept of using light sensitized nanotechnology to ablate individual cardiac cells in 2012. Virtually no destruction of healthy cells – no scarring. Perhaps. Seems a great idea… going nowhere.

    Too advanced to mesh with real-life EP research? Dead end?
    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3584703/

    Where should we be five or ten years from now? Next year? Will the direction we’re headed now get us there?

    Thanks so much for what you do.

    1. No one has any thoughts about this?

      Dr John – a blog entry perhaps: “Beyond the Horizon”??

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