Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy.
Cardiology Division, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Policlinico di Modena, Modena, Italy; Clinical and Experimental Medicine PhD Program, University of Modena and Reggio Emilia, Modena, Italy; Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart & Chest Hospital, Liverpool, United Kingdom.
Eur J Intern Med. 2021 Apr;86:1-11. doi: 10.1016/j.ejim.2021.01.006. Epub 2021 Jan 29.
The most recent atrial fibrillation (AF) guidelines delivered by European Society of Cardiology (ESC) offer an updated approach to AF management, with the perspective of improved characterization of the arrhythmia, the cardiac substrate and the patients profile in terms of associated risk factors and comorbidities. Recommendations were based on careful scrutiny and assessment of all available evidence with the final aim to offer to practitioners a lower level of uncertainty in the complex process of decision making for patients with AF. The 2020 ESC guidelines on AF propose a paradigm shift in the clinical approach to AF patients, moving from a single-domain AF classification to comprehensive characterization of AF patients. Given the complex nature of AF, an integrated holistic management of AF patients is suggested by the guidelines for improving patients outcomes through the formal introduction of the CC (Confirm AF and Characterize AF) to ABC (Atrial fibrillation Better Care) pathway. In line with this concept, these new guidelines underline the importance of a more comprehensive management of AF patients which should not be limited to simply prescribe oral anticoagulation or decide between a rhythm or rate control strategy. Indeed, each step of the ABC pathway represents one of the pivotal pillars in the management of AF and only a holistic approach has the potential to improve patients' outcomes. In this review we will discuss the background that supports some of the new recommendations of 2020 ESC guidelines, with important implications for daily management of AF patients.
欧洲心脏病学会 (ESC) 最近发布的心房颤动 (AF) 指南提供了一种更新的 AF 管理方法，从改善心律失常、心脏基质以及与危险因素和合并症相关的患者特征的角度出发。建议是基于对所有现有证据的仔细审查和评估，最终目的是为 AF 患者的复杂决策过程提供更低水平的不确定性。2020 年 ESC 关于 AF 的指南提出了 AF 患者临床方法的范式转变，从单一领域的 AF 分类转变为对 AF 患者的全面特征描述。鉴于 AF 的复杂性，指南建议通过正式引入 CC（确认 AF 和特征化 AF）到 ABC（AF 更好的护理）途径，对 AF 患者进行综合整体管理，以改善患者的预后。按照这一概念，这些新指南强调了更全面管理 AF 患者的重要性，不应仅限于简单地开口服抗凝药或在节律或心率控制策略之间做出决定。事实上，ABC 途径的每一步都代表了 AF 管理的关键支柱之一，只有整体方法才能有潜力改善患者的预后。在这篇综述中，我们将讨论支持 2020 年 ESC 指南中一些新建议的背景，这些建议对 AF 患者的日常管理有重要意义。
