The 2018 Korean Heart Rhythm Society Guidelines for Integrated Management of Korean patients with Nonvalvular Atrial Fibrillation

Background: Anticoagulants (OAC) decrease ischemic stroke rates in patients with atrial fibrillation (AF) but increase the risk of bleeding. The risk of ischemic stroke where the absolute benefit of anticoagulation outweighs the bleeding risk has been shown to be 1-2% per year. The American Heart Association/American College of Cardiology/Heart Rhythm Society and the European Society of Cardiology (ESC) guidelines have adopted the CHA2DS2-VASc stroke risk score; their recommendations assume the scheme’s point scores correspond to fixed stroke rates. However, reported rates of stroke vary widely across cohorts, placing in question the generalizability of guideline recommendations. Objective: To contrast the reported rates of stroke in North American (NA) patients with AF who do not take OAC with the Danish AF cohort used to create the ESC guidelines. Methods: We conducted a systematic review to identify all cohort studies and randomized controlled trials including patients with non-valvular AF not treated with OAC. We excluded studies that enrolled only patients undergoing surgical procedures or cardioversion, or only patients with specific comorbidities such as prior stroke or kidney disease. Results: Of the 3,552 studies screened, we identified 13 eligible NA studies representing 137,652 patients. Larger and more contemporary cohorts generally had lower stroke rates (Table). When weighted by number of subjects, the NA cohorts’ ischemic stroke rate averaged 1.88% per year, whereas the Danish cohort had a rate of 4.66% per year. Conclusions: Large variation exists in stroke rates across putatively representative cohorts. This may reflect true differences in rates or methodologic differences among studies. These differences could change the point score threshold for recommending OAC in lower risk regions. Reexamining the net benefit of OAC in patients with a CHA2DS2-VASc score of 1 or 2 seems warranted, particularly for those with weak 1-point risk factors.

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Current Anticoagulant Usage Patterns and Determinants in Korean Patients with Nonvalvular Atrial Fibrillation

Yonsei Medical Journal ◽

10.3349/ymj.2020.61.2.120 ◽

2020 ◽

Vol 61 (2) ◽

pp. 120

Author(s):

Hyun Su Ha ◽

Joongmin Kim ◽

Young Soo Lee ◽

Tae-Hoon Kim ◽

Jung Myung Lee ◽

...

Keyword(s):

Atrial Fibrillation ◽

Nonvalvular Atrial Fibrillation ◽

Korean Patients ◽

Usage Patterns

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2018 Korean Heart Rhythm Society Guidelines for Detection and Management of Risk Factors and Concomitant Cardiovascular Diseases in Korean Patients with Atrial Fibrillation

Korean Journal of Medicine ◽

10.3904/kjm.2018.93.4.324.e1 ◽

2018 ◽

Vol 93 (6) ◽

pp. 582-582

Author(s):

So-Ryoung Lee ◽

Young Soo Lee ◽

Woo-Hyun Lim ◽

Tae-Hoon Kim ◽

Myung-Jin Cha ◽

...

Keyword(s):

Risk Factors ◽

Atrial Fibrillation ◽

Cardiovascular Diseases ◽

Heart Rhythm ◽

Korean Patients ◽

Management Of Risk

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Atrial Fibrillation

10.2310/em.4006 ◽

2016 ◽

Author(s):

Tareq Al-Salamah ◽

Laura J. Bontempo

Keyword(s):

Atrial Fibrillation ◽

Rate Control ◽

Oral Anticoagulation ◽

Scoring System ◽

Treatment Guidelines ◽

Anticoagulation Therapy ◽

Heart Association ◽

Heart Rhythm ◽

Heart Beat ◽

Nonvalvular Atrial Fibrillation

Atrial fibrillation (AF) is a supraventricular tachyarrhythmia characterized by chaotic atrial electrical activity. It is associated with heart failure, stroke, and reduced quality of life. AF is frequently recurrent and refractory to treatment. These facts underscore the importance of recognizing this arrhythmia even in its asymptomatic form. This review covers the pathophysiology, stabilization and assessment, diagnosis and treatment, and disposition and outcomes of AF. Figures show AF, atrial flutter, and AF with preexcitation on a 12-lead electrocardiogram, rate control agent selection recommendations, and a decision-making algorithm for oral anticoagulation therapy. Tables list etiologies and risk factors for AF, American Heart Association/American College of Cardiology/Heart Rhythm Society classification of AF, some of the clinical consequences of AF, diagnostic evaluation for AF, antiarrhythmic drugs for conversion of AF, drugs used for acute rate control of AF, CHA2DS2-VASc score calculation, CHA2DS2-VASc adjusted stroke rate and treatment guidelines, scoring system to assess the risk of bleeding with oral anticoagulation: HAS-BLED (hypertension, abnormal renal/liver function, history of stroke, bleeding history or predisposition, labile international normalized ratio, elderly [65 years], drugs/alcohol concomitant), and HAS-BLED scores with proportion of patients from the Euro Heart Survey in each category and associated major bleeding risk. This review contains 5 highly rendered figures, 10 tables, and 69 references Key words: Atrial fibrillation; Supraventricular tachycardia; Irregular heart beat; Cardioversion; Nonvalvular atrial fibrillation; Paroxysmal atrial fibrillation; Rate control; CHA2DS2-VASc scoring system; Rhythm control

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The 2021 Korean Heart Rhythm Society Guidelines for a New Approach and Integrated Management of Atrial Fibrillation

Korean Journal of Medicine ◽

10.3904/kjm.2021.96.5.382 ◽

2021 ◽

Vol 96 (5) ◽

pp. 382-389

Author(s):

Junbeom Park ◽

Myung-Jin Cha ◽

Yong Soo Baek ◽

Min Soo Cho ◽

Boyoung Joung

Keyword(s):

Atrial Fibrillation ◽

Integrated Management ◽

Heart Rhythm ◽

Integrated Approach ◽

Current Approach ◽

Diagnosis And Treatment ◽

Team Members ◽

Consistent Treatment ◽

Treatment Policies ◽

Improve Patient

The prevalence of atrial fibrillation (AF) is gradually increasing with the aging of the population, and there is also increasing interest in AF with the development of various single-lead electrocardiography measurement methods for diagnosis. Further, the current diagnosis and treatment policies for AF do not reflect its progression and complexity. In addition, the various factors related to AF diagnosis and treatment are not simple due to the diversification of tools, advances in treatment methods, and complex mechanism of AF. Therefore, there are many challenges to developing a simple AF classification system. To overcome these, there have been a number of attempts to systematically characterize AF according to treatment and prognosis rather than using a uniform classification. Further, as mentioned in the previous AF guidelines, further research is being conducted on an integrated patient–physician approach to AF. Such an approach would be the basis for consistent treatment based on the guidelines, and would help to improve patient outcomes. Further, for the integrated management of AF patients, some changes should be made to the current approach to develop a multidisciplinary approach, including changes to the behavior of team members, patients, their family members, and physicians. The Korean Heart Rhythm will introduce an integrated approach to the classification and structure of AF management, and provide guidelines for its application in clinical practice.

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