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Clinical update

Atrial fibrillation risk, treatment and self-care: updated guidance

How to recognise and manage the symptoms of AF and advise patients on lifestyle adjustments

How to recognise and manage the symptoms of AF and advise patients on lifestyle adjustments

Essential facts

More than 1 million people in the UK have atrial fibrillation (AF) and an estimated half a million more have undiagnosed AF, according to the Stroke Association charity .

This condition causes an irregular and often abnormally fast heart rate and is also one of the most common causes of stroke, increasing the risk by five times.

Medical conditions that raise the likelihood of developing AF include: congenital heart disease, pericarditis, cardiomyopathy, coronary heart disease, diabetes, hyperthyroidism, hypertension, pneumonia, asthma, diabetes, pulmonary embolism, obesity and physical and mental stress.

Men are more commonly affected and prevalence

How to recognise and manage the symptoms of AF and advise patients on lifestyle adjustments

Picture: iStock

Essential facts

More than 1 million people in the UK have atrial fibrillation (AF) and an estimated half a million more have undiagnosed AF, according to the Stroke Association charity.

This condition causes an irregular and often abnormally fast heart rate and is also one of the most common causes of stroke, increasing the risk by five times.

Medical conditions that raise the likelihood of developing AF include: congenital heart disease, pericarditis, cardiomyopathy, coronary heart disease, diabetes, hyperthyroidism, hypertension, pneumonia, asthma, diabetes, pulmonary embolism, obesity and physical and mental stress.

Men are more commonly affected and prevalence increases with age.

What’s new?

In April, the National Institute for Health and Care Excellence (NICE) published updated guidance on diagnosing and managing AF.

This addresses several areas in which new evidence has become available since the guideline was first published in 2014.

These include the use of tools to calculate the risk of bleeding when considering using anticoagulants, the role of newer anti-clotting drugs, and the use of treatments that aim to destroy or isolate the abnormal sources of electrical impulses in the heart that may be driving AF.

There are also recommendations on managing those who present with acute AF and on preventing and managing postoperative AF.

Signs and symptoms

Symptoms of AF include palpitations that may feel like racing or fluttering; chest pain: finding it harder to exercise; tiredness; shortness of breath; dizziness or feeling faint.

AF may last for minutes or hours, with someone’s heartbeat returning to normal and no treatment needed, but it may also be persistent or permanent, requiring regular medication.

Many people have no pre-existing conditions, risk factors or obvious symptoms.

‘AF is typically detected as an irregular pulse or an irregular rhythm on an electrocardiogram (ECG),’ says NICE. ‘This may be an incidental finding or may arise while investigating symptoms suggestive of the disease. Because AF can be intermittent, detection and diagnosis may be challenging.’

As part of advice on self-management, nurses can show patients how to carry out their own manual pulse checks Picture: iStock

How you can help your patient

According to RCN guidance, ‘of those patients with a diagnosis of AF, half are untreated or poorly controlled’.

‘It is increasingly important to make sure people are identified and treated in a timely way and nursing staff are key in helping this to happen,’ it says.

Nurses can also help patients to understand more about their condition and what they can do to self-manage. This includes adopting a healthy lifestyle that may reduce the risk of stroke.

Remind patients that AF is a manageable condition and, with the right treatment to prevent complications and alleviate symptoms, they can continue to live a relatively normal life.

Patients should be offered a personalised package of care and information, says NICE. This should include who to contact for advice, psychological support, relevant and up-to-date information and support networks.

Expert comment

Jo Whitmore (pictured), senior cardiac nurse at the British Heart Foundation:

‘Although AF is common, it isn’t always an obvious diagnosis and symptoms can be overlooked.

‘Often people don’t experience any signs, with AF detected during a routine examination or check-up. This reinforces the need to carry out a manual pulse check and nurses should incorporate this into their routine contact with patients.

‘All nursing staff need to be aware of AF but those working in primary care, outpatients, emergency departments and walk-in centres are key to identifying those who may have it.

‘Nurses also play an important part in improving patients’ awareness of the different treatment and management options available.

‘They should communicate the potential risk of stroke, alongside the role of oral anticoagulation medicine in its prevention.

‘They can also show patients how to carry out their own manual pulse checks, help them to become familiar with AF symptoms and how to manage them, and ensure they have information to make informed choices regarding treatment options.’


Find out more

NICE: Atrial fibrillation – diagnosis and management (April 2021)

British Heart Foundation: AF resources

RCN: CVD prevention pathway and AF resources


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