I have just participated in a fantastic webinar outlining the new NICE guidelines for AF management in the clinical pharmacy / hospital pharmacy setting; see my notes below....

An excellent session providing clinicians with the essential tools and understanding needed to manage patients with AF in modern day healthcare.

Whilst the background to this commonly presenting medical complaint remains the same, there are a number of key considerations that build on previous protocols to avoid end organ damage and ultimately death (i.e. via stroke):

1. The ORBIT paradigm instead of the HASBLED score
2. The favoured use of DOACs compared to Warfarin
3. The control of heart rate, in the main, compared to rhythm

Importantly, the ORBIT model focusses more on those factors that can't be modified such as Hb, Age, PMH and Renal Function cf HASBLED. Here, the only variable factor considered is the choice of antiplatelet.

The use of DOACs is now favoured due to lower mortality when compared to warfarin, the comparability with warfarin in preventing stroke and the bleed risk being approximately equal.

Typically, we want to control the rate over the rhythm of the heart and therefore our prime choices are beta-blockers (i.e. Bisoprolol), calcium channel blockers (i.e. Diltiazem) and for those sedentary patients, Digoxin.

Should patients revert back to sinus rhythm, there may be adverse effects on the myocardium and therefore the risk of stroke is 'life long' and patients should be managed accordingly.

Additional aspects for consideration include:

1. Educating the patient in terms of stroke and bleeds
2. Acquiring up-to-date laboratory data (i.e. FBC/U&E/TSH)
3. Considering the extent of anaemia and renal function
4. The bleeding risk with other agents (i.e. SSRIs, NSAIDS and antiplatelets)
5. Cost savings for the NHS (i.e. Apixaban is looking good financially)
6. The fact that a switch to Apixaban may reduced the chance of stroke when compared to Edoxaban

This was a very informative webinar. The information delivered / acquired can be readily applied to support medical education and undergraduate / postgraduate development here at www.pharmascholar.co.uk. For more information and to book your (clinical) development session, please make contact via: mike@pharmascholar.co.uk