Atrial Fibrillation: Stroke Prevention in Focus
- Publication Type:
- Journal Article
- Australian Critical Care, 2014, 27 (2), pp. 92 - 98
- Issue Date:
Introduction: Atrial fibrillation (AF) is a common arrhythmia and a risk factor for stroke and other adverse events. Internationally there have been recent advancements in the therapies available for stroke prevention in AF. Nurses will care for individuals with AF across a variety of primary and acute care settings and should be familiar with evidence based therapies. Aim: This paper provides a review of the epidemiology of AF and stroke, stroke and bleeding risk assessment tools and evidence based treatments for the prevention of stroke in AF including the use of novel anti-thrombin agents. Method: A review of key databases was conducted from 2002 - 2012 using the key search terms 'atrial fibrillation' 'anticoagulation' 'risk assessment' and 'clinical management'. The following electronic databases were searched: CINAHL, Medline, Scopus, the Cochrane Library and Google Scholar. Reference lists were manually hand searched. Key clinical guidelines from National Institute for Clinical Excellence (NICE, UK), American Heart Association (AHA, USA), American College of Cardiology (ACC, USA) and the European Society of Cardiology (ESC) and key government policy documents were also included. Articles were included in the review if they addressed nursing management with a focus on Australia. Results: Many treatment options exist for AF. Best practice guidelines make a variety of recommendations which include cardioversion, ablation, pulmonary vein isolation, pharmacological agents for rate or rhythm control approaches, and antithrombotic therapy (including anticoagulation and antiplatelet therapy). Treatment should be patient centred and individualised based upon persistency of the rhythm, causal nature, risk and co-morbid conditions. Conclusion: AF is a common and burdensome condition where treatment is complex and not without risk. Nurses will encounter individuals with AF across a variety of primary and acute care areas understanding the risk of AF and appropriate therapies is important across all care settings. Treatment must be individually tailored to the needs of the patient and balanced with the best available evidence.
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