Print Print
CKS is no longer commissioned by the National Institute for Health and Clinical Excellence (NICE). NICE remains committed to providing a replacement service for CKS and is currently reviewing its options. In the meantime, although CKS content is now not being maintained, it still remains relevant and will continue to be made available. CKS content was generated under a programme of topic creation and update. To check if the topic you are viewing is current or out of date, please refer to the topic publication details by clicking on the 'How up-to-date is this topic?' link in the left hand menu on individual topic pages.

Atrial fibrillation - Management
How should I review someone with established atrial fibrillation?

  • Check for ongoing symptoms (at rest or with exercise) and assess heart rate.
    • If the person is taking rate-control treatment and has persistent symptoms or a fast heart rate, consider increasing the drug dose (if they are not taking the maximum dose), combining drug treatments (if this has not already been done), or referring to a cardiologist.
    • If the person is taking rhythm-control treatment and has recurring or persistent symptoms, refer back to a cardiologist for further assessment (for example for development of persistent atrial fibrillation [AF] or failed rhythm-control treatment).
  • Assess stroke and cardiovascular disease (CVD) risk.
    • If the person is not taking warfarin, reassess risk of stroke if they develop diabetes, hypertension, or cardiovascular disease or when they reach 65 and 75 years of age.
    • If the person is taking warfarin, reassess risk of bleeding (such as risk of falling).
    • For information on how to assess CVD risk, see the CKS topic on CVD risk assessment and management.
  • Check for complications of AF and assess blood pressure.
  • Review the person's medication.
    • Check compliance, and identify and manage drug interactions and complications (such as dyspepsia with aspirin).
    • Give advice on known drug interactions and which drugs should be avoided with aspirin or warfarin (see Prescribing information).
  • Provide information on AF.
    • Provide written information (if this has not already been given).
    • Explain when to seek further medical advice (such as worsening symptoms).
    • For more information on patient education and support groups, see www.atrialfibrillation.org.uk.

In depth

© NHS Institute for Innovation and Improvement