Christian T. Ruff, MD, MPH, prepared useful practice aids pertaining to atrial fibrillation for this CME/CE/CPE activity titled "Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation—Improving Detection, Reducing Risk." For the full presentation, monograph, complete CME/CNE/CPE information, and to apply for credit, please visit us at http://bit.ly/2FB4jdU. CME/CNE/CPE credit will be available until March 26, 2021.

1. Access the activity,“Making the Connection: A Call to Action Against Undiagnosed
Atrial Fibrillation,”at PeerView.com/NTH40
AAFP Updated Guideline on
Pharmacologic Management of
Newly Detected Atrial Fibrillation1
PRACTICE AID
AAFP: American Academy of Family Physicians; AF: atrial fibrillation; CHA2
DS2
-VASc: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/
thromboemolic event, vascular disease, age 65 to 74 years, sex category; CHADS2
: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/
thromboembolic event; HAS-BLED: hypertension, abnormal renal and liver function, stroke history, bleeding (prior major bleeding or predisposition to bleeding), labile INR, elderly (age >65
years), medication usage predisposing to bleeding and prior alcohol or drug usage history.
1. Hauk L. Am Fam Physician. 2017;96:332-333.
Recommendation 1
The AAFP strongly recommends rate control in preference to rhythm control for the
majority of patients with AF
Preferred options for rate-control therapy include non-dihydropyridine calcium channel
blockers and ß-blockers
Rhythm control may be considered for certain patients based on symptoms, exercise
tolerance, and patient preferences
Recommendation 2
The AAFP recommends lenient rate control (<110 bpm at rest) over strict rate
control (<80 bpm at rest) for patients with atrial fibrillation
Recommendation 3
The AAFP recommends that clinicians discuss the risk of stroke and bleeding with all
patients considering anticoagulation
Clinicians should consider using the continuous CHADS2 or continuous CHA2DS2-VASc
for prediction for risk of stroke and HAS-BLED for prediction of risk for bleeding in patients
with AF
Recommendation 4
The AAFP strongly recommends that patients with atrial fibrillation receive chronic
anticoagulation unless they are at low risk of stroke (CHADS2 <2) or have specific
contraindications
Choice of anticoagulation therapy should be based on patient preferences and patient
history. Options for anticoagulant therapy may include warfarin, apixaban, dabigatran,
edoxaban, or rivaroxaban
Recommendation 5
The AAFP strongly recommends against dual treatment with anticoagulant and
antiplatelet therapy in most patients who have atrial fibrillation
Strong recommendation,
high-quality evidence
Strong recommendation,
moderate-quality evidence
Weak recommendation,
low-quality evidence
Good practice point

2. Access the activity,“Making the Connection: A Call to Action Against Undiagnosed
Atrial Fibrillation,”at PeerView.com/NTH40
EHRA Atrial Fibrillation Screening
Method and AF-SCREEN
Recommended Populations
AF: atrial fibrillation; BP: blood pressure; EHRA: European Heart Rhythm Association; ESUS: embolic stroke of undetermined source; PPG: photoplethysmography.
1. Mairesse GH et al. Eurospace. 2017;19:1589-1623.
2. Freedman B et al. Circulation. 2017;135:1851-1867.
PRACTICE AID
Automated BP
measurement
Pulse palpation
Multi-lead patch recording
Handheld ECG devices
Implanted devices
Smartphone application
ECG confirmation
• Clinical evaluation
• 12-lead ECG
• Refer for
echocardiogram
• Treat underlying heart disease
• Assess risk of stroke
• Anticoagulation if needed
• Rate-control therapy
• Rhythm control if needed
European Heart Rhythm Association Atrial Fibrillation Screening Method1
AF-SCREEN Screening Recommendations2
Primary care or specialist
clinics
Non-medical healthcare
practitioners: Pharmacy
General populations:
Various venues
Where?
People aged ≥65 years
Patients aged <65 years +
enrichmenta
Whom?
• Opportunistic pulse
then ECG
• Single time point:
Single-lead ECG
• Patient activated ECG
(2-week): >75 years old
or younger if high risk
• Post-stroke ESUS:
Long-term continuous
Patient-activated devices:
Blood pressure/PPG
How?
AF-SCREEN preferred
Possible with further data
Clinical screening
ECG screening
a
Use of additional risk factors or biomarkers to increase the proportion with unknown AF in the screened population.

3. North American Thrombosis
Forum (NATF) Anticoagulant
Comparison Chart1,a
PRACTICE AID
Access the activity,“Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,”at
PeerView.com/NTH40
Warfarin
(Coumadin)
Dabigatran
(Pradaxa)
Rivaroxaban
(Xarelto)
Apixaban
(Eliquis)
Edoxaban
(Savaysa)
Generic? Yes No No No No
FDA approval
Pre-1982
Warfarin was first used in
humans in 1954, before
the FDA regulated drugs
October 2010 July 2011 December 2012 January 2015
FDA approved
for
• Stroke prevention
in AF and valve
replacements
• Treatment and
prevention of DVT
and PE
• Stroke prevention
in nonvalvular AF
• Treatment and
secondary
prevention of DVT
and PE
• VTE prevention
after hip
replacement
surgery
• Stroke prevention
in nonvalvular AF
• Treatment and
secondary
prevention of DVT
and PE
• VTE prevention
after hip and knee
replacement
surgery
• Stroke prevention
in nonvalvular AF
• Treatment and
secondary
prevention of DVT
and PE
• VTE prevention
after hip and knee
replacement
surgery
• Stroke prevention
in nonvalvular AF
• Treatment and
secondary
prevention of DVT
and PE
Drug image
Available
strengths
Variable
75-mg, 110-mg, or
150-mg capsule
10-mg, 15-mg, or
20-mg tablet
5-mg or 2.5-mg tablet
15-mg, 30-mg, or
60-mg tablet

4. North American Thrombosis
Forum (NATF) Anticoagulant
Comparison Chart1,a
a
Betrixaban is not approved for treatment of atrial fibrillation.
AF: atrial fibrillation; NATF: North American Thrombosis Forum; PE: pulmonary embolism; VTE: venous thromboembolism.
1. https://natfonline.org/wp-content/uploads/2018/01/Anticoagulant-Comparison-Chart-Jan2018.pdf. Accessed April 11, 2018.
PRACTICE AID
Access the activity,“Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,”at
PeerView.com/NTH40
Warfarin
(Coumadin)
Dabigatran
(Pradaxa)
Rivaroxaban
(Xarelto)
Apixaban
(Eliquis)
Edoxaban
(Savaysa)
Dosing
frequency
Once daily Twice daily
Once daily
Following a 3-week
loading period of twice
daily for PE and DVT
Twice daily
Following a 1-week
loading period of 10 mg
twice daily for PE and DVT
Once daily
Onset
Slow
Several days
Fast
A few hours
Fast
A few hours
Fast
A few hours
Fast
A few hours
Kidney
function
No
Yes
Kidney function affects
the dosage
Yes
Kidney function affects
the dosage
Yes
Kidney function affects
the dosage
Yes
Kidney function affects
the dosage
Food effect
Yes
Speak with your provider
about vitamin K intake
and warfarin
No
Yes
Rivaroxaban should be
taken with dinner
No No
Drug
interactions
Many Few Few Few Few
Routine lab
monitoring
Yes No No No No
Reversal
agents
Yes
Vitamin K, fresh frozen
plasma, prothrombin
complex concentrates
Yes
Idarucizumab
Yes
Coagulation factor Xa
(recombinant),
inactivated-zhzo
[andexanet alfa]
Yes
Coagulation factor Xa
(recombinant),
inactivated-zhzo
[andexanet alfa]
Soon
May use prothrombin
complex concentrates
in emergencies

5. Atrial Fibrillation Screening:
Risk Calculators, Tools, and
Additional Resources
PRACTICE AID
Access the activity,“Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,”at
PeerView.com/NTH40
Risk Factor Points
CHF 1
Hypertension 1
Age ≥75 years 1
Diabetes mellitus 1
Stroke/TIA/embolism 2
Maximum score 6
Risk Factor Points
CHF/LV dysfunction 1
Hypertension 1
Age ≥75 years 2
Diabetes mellitus 1
Stroke/TIA/embolism 2
Vascular disease 1
Age 65-74 years 1
Sex category (female) 1
Maximum score 9
Clinical
Characteristic
Points
H Hypertension 1
A
Abnormal liver and/or
renal function
1 each;
max. of 2
S Stroke 1
B Bleeding 1
L Labile INR 1
E Elderly (age >65) 1
D Drugsa
and/or alcohol 1 each;
max. of 2
Maximum score 9
CHADS2 Risk Score for
Prediction of Stroke Risk in AF
CHA2DS2-VASc Risk Score for
Prediction of Stroke Risk in AF
HAS-BLED Risk Calculator for
Predicting Risk of Bleeding
With Anticoagulation
Additional Resources for Physicians
• NATF Atrial Fibrillation Action Initiative
• NATF AF Action Initiative Document
• Arrhythmia Alliance Homepage
• Arrhythmia Alliance “AF and How AF Causes Stroke” (video)
• AAFP Clinical Practice Guideline on Atrial Fibrillation
a
Aspirin/NSAIDs.

6. Atrial Fibrillation Screening:
Risk Calculators, Tools, and
Additional Resources
AAFP: American Academy of Family Physicians; AF: atrial fibrillation; BP: blood pressure; CHA2
DS2
-VASc: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboemolic event, vascular disease, age
65 to 74 years, sex category; CHADS2
: congestive heart failure, hypertension, age ≥75 years, diabetes mellitus, stroke/transient ischemic attack/thromboembolic event; HAS-BLED: hypertension, abnormal renal and liver function, stroke history, bleeding
(prior major bleeding or predisposition to bleeding), labile INR, elderly (age >65 years), medication usage predisposing to bleeding and prior alcohol or drug usage history; INR: International Normalized Ratio; LV: left ventricular; NATF: North American
Thrombosis Forum.
1. www.afscreen.org. Accessed March 30, 2018.
2. Chan P-H et al. J Am Heart Assoc. 2016;5:e003428.
PRACTICE AID
Access the activity,“Making the Connection: A Call to Action Against Undiagnosed Atrial Fibrillation,”at
PeerView.com/NTH40
Screening Tools for Atrial Fibrillation1,2
Radial pulse measurement
Insertable
cardiac monitor
BP monitor
Smartphone-based
heart rate monitor
Home heart rate monitor
Heart rate monitor patch