NICE updates guideline on atrial fibrillation

The UK’s National Institute for Health and Care Excellence has published an updated clinical guideline on the diagnosis and management of atrial fibrillation (AF) addressing several areas of new evidence.

The updated guideline includes new evidence since the publication of NICE’s previous guideline in 2014.

This includes the use of tools to calculate the risk of bleeding when considering the use of anticoagulants, the role of newer anti-clotting drugs and the use of treatments that aim to destroy/isolate the abnormal source of electrical impulses in the heart that may drive AF.

In a statement, NICE said that accurate knowledge of bleeding risk supports shared decision and also has practical benefit.

In addition, evidence has shown that a tool known as ORBIT is the most accurate for predicting the risk of bleeding in people with AF.

However, the guideline acknowledges that other bleeding risk tools, including the HAS-BLED tool which NICE previously recommended, can be used until the ORBIT tool is embedded in clinical pathways and electronic systems.

Furthermore, the new guideline recommends that anticoagulation with certain drugs – direct-acting oral coagulants – should be offered to people with AF and a high risk of stroke.

NICE has recommended apixaban, dabigatran, edoxaban and rivaroxaban as options when used in line with the criteria specified in the relevant technology appraisal guidance.

The guideline also specifies that when drug treatment is unsuccessful, unsuitable or not tolerated in people with symptomatic intermittent or persistent AF, radiofrequency point-by-point ablation should be considered.

If this is not suitable, however, cryoballoon ablation or laser balloon ablation can be considered.