నైరూప్య

New atrial fibrillation guidelines: implementation in the clinic

Giuseppe Di Pasquale and Letizia Riva

The adherence to guidelines in atrial fibrillation (AF) management is not satisfactory. In particular, oral anticoagulant therapy is underused in AF patients and is not prescribed in accordance with thromboembolic risk. Moreover, the quality of oral anticoagulant therapy is suboptimal, with intensity often outside the target range (International Normalized Ratio: 2.0–3.0) and discontinuation after starting warfarin is substantial. Regarding therapeutic strategies, the choice between rhythm control and rate control is not driven by AF symptoms and the adherence to guidelines for AF substrate catheter ablation is moderate. AF patients are different from AF trial patients, in particular for age and comorbidities. Therefore, it is not surprising that relevant gaps exist between the results of research and their application in clinical practice. Database, registries, comparison among different medical centers and an active involvement of practicing clinicians may play a pivotal role for the assessment of guidelines adherence.