• Juan G Ripoll, Marvin G Chang, Edward A Bittner, Jamel Ortoleva, Maryna Khromava, Derek T Bradley, Emily K Griffin, Juan C Diaz Soto, Patrick M Wieruszewski, Kitae Chang, Christoph S Nabzdyk, and Harish Ramakrishna.
• Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, MN.
• J. Cardiothorac. Vasc. Anesth. 2024 Nov 26.

AbstractThe 2024 European Society of Cardiology guidelines for atrial fibrillation (AF) emphasize a patient-centered approach to management, structured around the AF-CARE pathway: Comorbidity and risk factor management (C), Avoiding stroke and thromboembolism (A), Reducing symptoms through rate and rhythm control (R), and Evaluation and dynamic reassessment (E). This framework ensures that comorbidities such as hypertension, heart failure, diabetes, and obesity are effectively managed to prevent disease progression and improve outcomes. A key principle of the guidelines is shared decision making involving patients, families, caregivers, and healthcare teams to ensure individualized care that reflects patient preferences. The guidelines also stress healthcare equity, advocating for the elimination of disparities related to sex, ethnicity, disability, and socioeconomic status. For diagnosis, electrocardiographic confirmation of clinical AF is essential, followed by risk stratification using the CHA₂DS₂-VASc score to guide anticoagulation therapy. Direct oral anticoagulants are preferred for most patients because of their good safety profile. Stroke prevention is prioritized, with rhythm control as first-line treatment for suitable patients. For those with persistent symptoms despite medications, catheter ablation is recommended. Rate control strategies, including beta-blockers, digoxin, and calcium channel blockers, are used to manage heart rate and symptoms. Ongoing education for patients, families, and providers supports informed decision making and dynamic reassessment, optimizing patient outcomes and quality of life.Copyright © 2024 Elsevier Inc. All rights reserved.

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