• 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.
• Identify and manage existing heart failure or hypertension — see the CKS topics on Heart failure - chronic and Hypertension - not diabetic.
• 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

• Advise the person that it is their responsibility to inform the Driver and Vehicle Licensing Agency (DVLA) of any condition that may affect their ability to drive.
• The DVLA's medical rules regarding atrial fibrillation are:
• For group 1 entitlement (cars, motorcycles):
• Driving must cease if the arrhythmia has caused or is likely to cause incapacity.
• Driving may be permitted when the underlying cause has been identified and controlled for at least 4 weeks
• The DVLA need not be notified unless there are distracting or disabling symptoms.
• For group 2 entitlement (lorries, buses):
• Disqualified from driving if the arrhythmia has caused or is likely to cause incapacity.
• Driving may be permitted when the arrhythmia is controlled for at least 3 months; the left ventricular ejection fraction is equal to or greater than 0.4; there is no other disqualifying condition.
• The person should check with their insurer that they are still covered for driving.
• The latest information from the DVLA regarding medical fitness to drive can be obtained at www.dvla.gov.uk/medical/ataglance.

In depth

In depth

• Advise the person that there are no flying restrictions provided they have stable atrial fibrillation which has not recently worsened or become more symptomatic.

In depth

In depth