Guidelines for preventive activities in general practice

Cardiovascular

Atrial fibrillation

      1. Atrial fibrillation

Cardiovascular | Atrial fibrillation

Case finding age bar

0–9 10–14 15–19 20–24 25–29 30–34 35–39 40–44 45–49 50–54 55–59 60–64 65–69 70–74 75–79 ≥80

Atrial fibrillation (AF) is the most common recurrent arrhythmia in Australia, with estimates suggesting that approximately 2–4% of the Australian population has AF and prevalence increasing with age.1,2 It is expected that AF cases in people aged ≥55 years will increase over the next 20 years due to the ageing population and improved survival from contributory diseases.1

AF can be persistent or paroxysmal. Although AF can be symptomatic (transient ischaemic attack [TIA], stroke, breathlessness, reduced exercise capacity, palpitations, syncope or dizziness, fatigue, weakness, chest discomfort),2–4 it can also be asymptomatic.1 Clinical AF is known to increase stroke risk,5,6 but the stroke risk associated with subclinical AF, particularly low-burden or short-duration AF, is less well understood.5,7,8 As of 2018, AF was listed as the underlying or associated cause of over 14,000 deaths in Australia (9.0% of total deaths).2

Screening for AF in asymptomatic people is undertaken to determine whether someone is at sufficiently high risk to require oral anticoagulants to prevent a thromboembolic event.

Screening

Recommendation Grade How often References
Screening for AF, with an electrocardiogram (ECG) or other device, has insufficient evidence to assess the balance of benefits and harms in adults aged ≥50 years without:
  • a diagnosis or symptoms of AF
  • a history of TIA or stroke.
Practice point N/A 5

Case finding

Recommendation Grade How often References
Opportunistic clinical palpation or auscultation is recommended to detect asymptomatic AF in people aged ≥65 years (in the clinic or community).
If irregular, this should be followed by an ECG, or by an ECG rhythm strip using a handheld ECG. The presence of AF can be missed when using automatic blood pressure machines.
Recommended (Strong) Opportunistically. 1
 
Apart from increasing age, AF risk factors and comorbidities include:1,9–13
  • hypertension
  • heart failure
  • coronary artery disease
  • valvular heart disease
  • obesity
  • diabetes
  • chronic kidney disease
  • family history of AF
  • smoking
  • obstructive sleep apnoea
  • alcohol
  • thyroid disease.

For specific recommendations for Aboriginal and Torres Strait Islander people, please refer to the Cardiovascular disease prevention chapter in the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.

  1. NHFA CSANZ Atrial Fibrillation Guideline Working Group; Brieger D, Amerena J, et al. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian clinical guidelines for the diagnosis and management of atrial fibrillation 2018. Heart Lung Circ. 2018;27(10):1209–66. doi: 10.1016/j.hlc.2018.06.1043.
  2. Australian Institute of Health and Welfare. Atrial fibrillation in Australia. Australian Government, 2020 [Accessed 16 May 2023].
  3. National Institute for Health and Care Excellence (NICE). Atrial fibrillation: diagnosis and management. NICE, 2021 [Accessed 16 May 2023].
  4. Yi JE, Lee YS, Choi EK, et al. CHA2DS2-VASc score predicts exercise intolerance in young and middle-aged male patients with asymptomatic atrial fibrillation. Sci Rep 2018;8:18039. doi: 10.1038/s41598-018-36185-7.
  5. US Preventive Services Task Force; Davidson KW, Barry MJ, et al. Screening for atrial fibrillation: US Preventive Services Task Force recommendation statement. JAMA 2022;327(4):360–67. doi: 10.1001/jama.2021.23732.
  6. Wolf P, Abbott R, Kannel W. Atrial fibrillation as an independent risk factor for stroke: The Framingham Study. Stroke 1991;22(8):983–88. doi: 10.1161/01.STR.22.8.983.
  7. Noseworthy P, Kaufman E, Chen L, et al. Subclinical and device-detected atrial fibrillation: Pondering the knowledge gap: A scientific statement from the American Heart Association. Circulation. 2019;140(25): e944–63. doi: 10.1161/CIR.0000000000000740.
  8. Benjamin E, Go A, Desvigne-Nickens P, et al. Research priorities in atrial fibrillation screening: A report from a National Heart, Lung, and Blood Institute virtual workshop. Circulation 2021;143(4):372–88. doi: 10.1161/CIRCULATIONAHA.120.047633.
  9. Ball J, Carrington M, McMurray J, et al. Atrial fibrillation: Profile and burden of an evolving epidemic in the 21st century. Int J Cardiol. 2013;167(5):1807–24. doi: 10.1016/j.ijcard.2012.12.093.
  10. Briffa T, Hung J, Knuiman M, et al. Trends in incidence and prevalence of hospitalization for atrial fibrillation and associated mortality in Western Australia, 1995–2010. Int J Cardiol 2016; 208:19–25. doi: 10.1016/j.ijcard.2016.01.196.
  11. Verma K, Wong M. Atrial fibrillation. Aust J Gen Pract 2019;48(10):694–99. doi: 10.31128/AJGP-12-18-4787.
  12. Gallagher C, Hendriks JML, Elliott AD, et al. Alcohol and incident atrial fibrillation – a systematic review and meta-analysis. Int J Cardiol. 2017;246:46–52. doi: 10.1016/j.ijcard.2017.05.133.
  13. Al-Makhamreh H, Al-Ani A, Alkhulaifat D, et al. Impact of thyroid disease in patients with atrial fibrillation: Analysis from the JoFib registry. Ann Med Surg (Lond). 2022;74:103325. doi: 10.1016/j.amsu.2022.103325.
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