From the Guidelines
The primary care treatment for atrial fibrillation (AFib) should focus on rate control using beta-blockers, diltiazem, verapamil, or digoxin as first-choice drugs in patients with AF and LVEF >40% to control heart rate and reduce symptoms. According to the 2024 ESC guidelines for the management of atrial fibrillation 1, rate control therapy is recommended as initial therapy in the acute setting, an adjunct to rhythm control therapies, or as a sole treatment strategy. The guidelines suggest the use of beta-blockers, diltiazem, verapamil, or digoxin as first-line treatments for rate control in patients with AF and LVEF >40%.
Key considerations for treatment include:
- Controlling heart rate and reducing symptoms
- Using beta-blockers, diltiazem, verapamil, or digoxin as first-choice drugs
- Considering atrioventricular node ablation combined with cardiac resynchronization therapy in severely symptomatic patients with permanent AF and at least one hospitalization for HF, as recommended by the 2024 ESC guidelines 1.
In clinical practice, the treatment of AFib should prioritize reducing morbidity, mortality, and improving quality of life, and the choice of treatment should be individualized based on patient characteristics and symptoms. The 2024 ESC guidelines provide a framework for managing AFib, and primary care physicians should manage uncomplicated cases while referring complex presentations to cardiology.
From the FDA Drug Label
The primary objective of ARISTOTLE was to determine whether apixaban 5 mg twice daily (or 2. 5 mg twice daily) was effective (noninferior to warfarin) in reducing the risk of stroke (ischemic or hemorrhagic) and systemic embolism. Apixaban was superior to warfarin for the primary endpoint of reducing the risk of stroke and systemic embolism (Table 9 and Figure 4). Apixaban also showed significantly fewer major bleeds than warfarin [see Adverse Reactions (6. 1)].
The primary care treatment for atrial fibrillation (AFib) is anticoagulation therapy, with options including apixaban or warfarin, to reduce the risk of stroke and systemic embolism.
- Apixaban has been shown to be superior to warfarin in reducing the risk of stroke and systemic embolism, with significantly fewer major bleeds 2.
- The dosage of apixaban is 5 mg orally twice daily, or 2.5 mg twice daily in patients with certain characteristics, such as age ≥80 years, body weight ≤60 kg, or serum creatinine ≥1.5 mg/dL.
From the Research
Primary Care Treatment for Atrial Fibrillation (AFib)
The primary care treatment for atrial fibrillation (AFib) involves two main strategies:
- Rate control: to modulate ventricle rate, alleviate adverse associated symptoms, and improve the quality of life 3
- Rhythm control: to prevent stroke and systemic embolism, and symptom control with either a rate or a rhythm control strategy 4, 5
Treatment Options
Treatment options for AFib include:
- Pharmacotherapy: such as beta-blockers, non-dihydropyridine calcium channel blockers, and antiarrhythmic medications 4, 3
- Catheter ablation: to restore a normal heart rhythm 6
- Left atrial appendage closure: to prevent stroke and systemic embolism 6
- The maze procedure: a surgical procedure to treat AFib 6
Management of AFib
Management of AFib involves:
- Prevention of stroke and systemic embolism: through the use of anticoagulation therapy, such as warfarin or novel oral anticoagulants (NOACs) 7
- Symptom control: through the use of rate or rhythm control strategies 4, 5
- Modulation of factors that promote AFib or its complications: such as hypertension, heart failure, and coronary artery disease 4