心房纤颤Atrial fibrillation.ppt

Changing clinical practice NICE guidelines are based on the best available evidence The Department of Health asks NHS organisations to work towards implementing guidelines Compliance will be monitored by the Healthcare Commission Atrial fibrillation Atrial fibrillation (AF) is an atrial tachyarrhythmia characterised by predominantly uncoordinated atrial activation with consequent deterioration of atrial mechanical function On the ECG, there is an absence of consistent P waves; instead there are rapid oscillations or fibrillatory waves that vary in size, shape and timing Several causes of AF Often caused by co-existing medical conditions – both cardiac and non-cardiac Associated with increasing age, hypertension, heart failure, diabetes mellitus and valve disease Dietary and lifestyle factors have also been associated with AF Common after surgery, especially cardiothoracic operations Need for this guideline AF is a significant risk factor for mortality, as well as stroke and other morbidities AF is the commonest sustained cardiac arrhythmia Too often, AF is detected only after the patient presents with serious complications of AF AF incidence and prevalence increase with increasing age. With an increasingly elderly population, AF is likely to become more common Commonest cardiac arrhythmia The prevalence of AF roughly doubles with each decade of age: from 0.5% at age 50–59 years to almost 9.0% at age 80–90 years Present in 3–6% of acute hospital admissions Prevalence of 4.7% of people aged 65 years or over in general practice Prevalence of AF in the Renfrew-Paisley study What needs to happen Opportunistic/targeted case detection including taking a manual pulse to detect AF Accurate diagnosis of AF using an ECG Further investigations and clinical assessment, including risk stratification for stroke/thromboembolism Development of a management plan – rate-control, rhythm-control or referral Antithrombotic therapy as appropriate Follow-up and review AF c