New CARE pathway in 2024 ESC guidelines for management of AF

The 2024 ESC Guidelines for the Management of Atrial Fibrillation were presented at the ESC Congress by Isabelle van Gelder and Dipak Kotecha  (Groningen, The Netherlands and Birmingham, UK). The pathway of AF-CARE was introduced and explained by the chair persons of the guidelines.

Highlights of the guidelines

• The CARE pathway has been introduced:
  • C – comorbidities and risk factor management
  • A – avoid stroke and thromboembolism
  • R – reduce symptoms by rate and rhythm control
  • E – evaluation and dynamic reassessment
• Identification and treatment of comorbidities and risk factors is placed as the initial and central component of patient management (for all types of AF), as it is crucial for success of all other aspects of care for patients with AF.
• Key targets for (risk) factors have been set, but it is important to set individual targets and induce behavioral change (by shared decision-making, focus on key risk factors, provide information without overloading, and achievable targets).
• Avoid stroke and thromboembolism is key to prevent avoidable adverse outcomes. Use locally validated risk scores or the CHA₂DS₂-VA score. Bleeding risk scores should not be used to decide on starting or withdrawing anticoagulants.
• Rate and rhythm control is essential to improve patient quality of life. Use rate controlling drugs as initial therapy in the acute setting, adjunct to rhythm control therapy, or sole treatment to control heart rate and symptoms. Consider rhythm control in all suitable patients. Safety comes first: cardioversion is not recommended if AF duration is>24 hours, unless the patient has already received at least 3 weeks of therapeutic OAC or a TOE is performed to exclude intracardiac thrombus. 
• There are recommendations on interventional rhythm control.
• Evaluation and dynamic reassessment is critical for longer term management of AF. Periodically reassess therapies and give attention to new modifiable risk factors.

- Our reporting is based on the information provided at the ESC Congress 2024 -

The guidelines are published in Eur Heart J