(ACC/AHA) scientific statement on clinical performance measures for adults with atrial fibrillation (AF) or atrial flutter (AFl).

Citation: J Am Coll Cardiol. 2008;51:865-884.

Author(s): Estes NA, Halperin JL, Calkins H, et al.

Perspective: The following are 10 points to remember from this American College of Cardiology/American Heart Association (ACC/AHA) scientific statement on clinical performance measures for adults with atrial fibrillation (AF) or atrial flutter (AFl).

1. Antithrombotic therapy is indicated for all patients with AF except those with lone AF or contraindications.

2. Assessment of thromboembolic risk factors should include prior stroke/transient ischemic attack (TIA), age ≥75 years, hypertension, diabetes, and heart failure or left ventricular (LV) systolic dysfunction.

3. Prior stroke/TIA is the strongest risk factor and is an indication for anticoagulation with warfarin.

4. Rheumatic mitral stenosis also is a strong risk factor for stroke and is an indication for warfarin even if no other risk factors are present.

5. Warfarin also is indicated for patients with >1 moderate risk factor (age ≥75 years, hypertension, diabetes, and heart failure/LV systolic dysfunction.

6. Aspirin may be used for stroke prevention in patients without any risk factors.

7. Antithrombotic therapy (warfarin or aspirin) should be used on an individualized basis in patients with one moderate risk factor.

8. The international normalized ratio (INR) initially should be measured at least once per week and then once per month after a stable degree of anticoagulation when an INR of 2-3 is achieved.

9. When aspirin is used for stroke prevention, the daily dose should be 81-325 mg/day.

10. Patients with AFl should receive antithrombotic therapy in the same fashion as patients with AF. Fred Morady, M.D., F.A.C.C.