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Spotlight on the 2024 ESC/EACTS management of atrial fibrillation guidelines: 10 novel key aspects
Open accessAbstract
Atrial fibrillation (AF) remains the most common cardiac arrhythmia worldwide and is associated with significant morbidity and mortality. The European Society of Cardiology (ESC)/European Association for Cardio-Thoracic Surgery (EACTS) have recently released the 2024 guidelines for the management of AF. This review highlights 10 novel aspects of the ESC/EACTS 2024 Guidelines. The AF-CARE framework is introduced, a structural approach that aims to improve patient care and outcomes, comprising of four pillars: [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, and [E] Evaluation and dynamic reassessment. Additionally, graphical patient pathways are provided to enhance clinical application. A significant shift is the new emphasis on comorbidity and risk factor control to reduce AF recurrence and progression. Individualized assessment of risk is suggested to guide the initiation of oral anticoagulation to prevent thromboembolism. New guidance is provided for anticoagulation in patients with trigger-induced and device-detected sub-clinical AF, ischaemic stroke despite anticoagulation, and the indications for percutaneous/surgical left atrial appendage exclusion. AF ablation is a first-line rhythm control option for suitable patients with paroxysmal AF, and in specific patients, rhythm control can improve prognosis. The AF duration threshold for early cardioversion was reduced from 48 to 24 h, and a wait-and-see approach for spontaneous conversion is advised to promote patient safety. Lastly, strong emphasis is given to optimize the implementation of AF guidelines in daily practice using a patient-centred, multidisciplinary and shared-care approach, with the simultaneous launch of a patient version of the guideline.
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![Figure 1 AF-CARE framework. AF, atrial fibrillation; CARE, [C] Comorbidity and risk factor management, [A] Avoid stroke and thromboembolism, [R] Reduce symptoms by rate and rhythm control, [E] Evaluation and dynamic reassessment. Adapted from EHJ 2024.4](/paper-figures/058d1e56b3f6442fa6754132aedd0397/spotlight-on-the-2024-esc-eacts-management-of-atrial-fibrillation-guidelines-10-figure-1.jpg)
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“The CHA2DS2-VA score is a reliable risk scale for prescribing oral anticoagulants (OAC) [88].”
From Atrial Fibrillation in Elite Athletes: A Comprehensive Review of the Literature (2024) · cites this paper as [88]
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Metadata
- Authors
- Rienstra, M., Tzeis, S., Bunting, K. V., Caso, V., Crijns, H. J. G. M., De Potter, T. J. R., Sanders, P., Svennberg, E., Casado-Arroyo, R., Dwight, J., Guasti, L., Hanke, T., Jaarsma, T., Lettino, M., Løchen, M.-L., Lumbers, R. T., Maesen, B., Mølgaard, I., Rosano, G. M. C., Schnabel, R. B., Suwalski, P., Tamargo, J., Tica, O., Traykov, V., Kotecha, D., & Van Gelder, I. C.
- Affiliations
- University Medical Center Groningen (NL)
- Mitera Hospital (GR)
- University of Birmingham (GB)
- University of Perugia (IT)
- Maastricht University Medical Centre (NL)
- Department of Cardiology, OLV Hospital , Aalst ,
- Royal Adelaide Hospital (AU)
- Karolinska University Hospital (SE)
- Department of Cardiology, H.U.B.-Hôpital Erasme, Université Libre de Bruxelles , Brussels ,
- European Society of Cardiology (FR)
- University of Insubria (IT)
- Asklepios Klinikum Harburg (DE)
- Linköping University (SE)
- Department for Cardiac, Thoracic and Vascular Diseases, Fondazione IRCCS San Gerardo dei Tintori , Monza ,
- University Hospital of North Norway (NO)
- University College Hospital (GB)
- ESC Patient Forum, Sophia Antipolis ,
- St George's, University of London (GB)
- Universität Hamburg (DE)
- National Medical Institute of the Ministry of Interior and Administration (PL)
- Universidad Complutense de Madrid (ES)
- Institute of Cardiovascular Sciences, University of Birmingham , Birmingham ,
- Tokuda Hospital (BG)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- Department of Cardiology, University of Groningen, University Medical Center Groningen , P.O. Box 30.001, 9700 RB Groningen ,
- Corresponding author
- Rienstra, Michiel
- ORCID
- Rienstra, Michiel
- Tzeis, Stylianos
- Bunting, Karina V
- Caso, Valeria
- Crijns, Harry J G M
- De Potter, Tom J R
- Sanders, Prashanthan
- Svennberg, Emma
- Casado-Arroyo, Ruben
- Guasti, Luigina
- Hanke, Thorsten
- Jaarsma, Tiny
- Lettino, Maddalena
- Løchen, Maja-Lisa
- Lumbers, R Thomas
- Maesen, Bart
- Rosano, Giuseppe M C
- Schnabel, Renate B
- Suwalski, Piotr
- Tamargo, Juan
- Tica, Otilia
- Traykov, Vassil
- Kotecha, Dipak
- Van Gelder, Isabelle C
- Venue
- Europace
- Publisher
- Oxford University Press (OUP)
- Published
- 2024-12
- Volume
- 26
- Issue
- 12
- ISSN
- 1099-5129 (ISSN-L)
- 1532-2092
- PMC
- PMC11666470
- OpenAlex
- W4405728415
- Cited by
- 128
- References
- 144
- Citations by year
- 2026: 62 · 2025: 65 · 2024: 1
- FWCI
- 10.15
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- EP Europace (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- University of Birmingham Research Portal (University of Birmingham) (publishedVersion, cc-by)
- St George's Online Research Archive (St George's University of London) (submittedVersion)
- KTH Publication Database DiVA (KTH Royal Institute of Technology) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- Utrecht University Repository (Utrecht University) (submittedVersion, other-oa)
- IrInSubria (University of Insubria) (submittedVersion, other-oa)
- University of Groningen research database (University of Groningen / Centre for Information Technology) (submittedVersion, cc-by)
- Funders
- Bayer
- InCarda Therapeutics
- Dutch Cardiovascular Alliance
- ZonMw
- Dutch Heart Foundation (848090001, 2018B017)
- Netherlands Cardiovascular Research Initiative
- Horizon 2020 (847770)
- Pfizer
- EVER Neuro Pharma
- Bayer AG
- Boehringer-Ingelheim
- Daiichi Sankyo
- Sanofi
- Roche Diagnostics
- Acesion Pharma
- Boston Scientific
- Biosense Webster
- Adagio Medical
- Abbott Vascular
- Medtronic
- CathRx
- Pacemate
- Boston Scientific, Medtronic, Abbott, and Becton Dickenson
- Astra Zeneca
- Johnson and Johnson
- Merck Sharp & Dohme
- St. Jude Medical
- Oxford University Press
- PassPACES
- Royal College of Physicians
- AtriCure
- BioVentrix
- Edwards Lifesciences
- Amarin Corporation
- Health Data Research UK
- Medical Research Council
- National Institutes of Health
- Pfizer Innovative Target Exploration Network
- HealthLumen
- Fitfile
- Norgine BV
- Danish Heart Association
- Vifor International
- Menarini Group
- AstraZeneca
- Abbott Laboratories
- European Research Council
- German Centre for Cardiovascular Research (81Z1710103, 81Z0710114)
- ERACoSysMed3 (031L0239)
- Horizon Europe (101095480)
- EU
- German Ministry for Research and Technology (BMBF 01ZX1408A)
- Bristol Myers Squibb
- Bayer HealthCare
- Sun Wave Pharma
- Teva Pharmaceutical Industries
- Biotronik
- National Institute for Health Research (NIHR CDF-2015-08-074 RATE-AF, NIHR130280 DaRe2THINK, NIHR132974 D2T-NeuroVascular, NIHR203326)
- British Heart Foundation (FS/CDRF/21/21032, PG/17/55/33087, AA/18/2/34218)
- Innovative Medicines Initiative
- EU Horizon
- R&D Subnational Secure Data Environment Programme
- Pioneer Fund
- Cook and Wolstenholme Charitable Trust
- European Society of Cardiology
- Biomedical Research Centre
- University of Birmingham
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Clinical practice guidelines implementation
- Keywords
- atrial fibrillation, oral anticoagulation, rate and rhythm control, left atrial appendage exclusion, atrial fibrillation ablation, paroxysmal atrial fibrillation, shared care, care pathways
- MeSH terms
- Anti-Arrhythmia Agents, Anticoagulants, Atrial Fibrillation, Cardiology, Europe, Humans, Risk Factors, Thromboembolism, Comorbidity, Treatment Outcome, Catheter Ablation, Practice Guidelines as Topic, Risk Assessment, Stroke
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