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KEY POINTS

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  • Atrial fibrillation (AF) is a common supraventricular tachycardia.

  • The management of AF centers on rate as well as rhythm control and prevention of stroke.

  • Risk of thromboembolic stroke must be assessed in every patient with AF so that appropriate preventive measures can be implemented. MTM providers should be familiar with risk assessment tools and strategies for stroke prevention.

  • Medications used for stroke prevention, rate control, and rhythm control in AF have many important drug interactions (eg, warfarin, amiodarone). MTM providers should be vigilant for drug interactions in patients with AF, and when possible, recommend alternative therapies for other disorders that minimize the risk of significant interactions.

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INTRODUCTION TO ATRIAL FIBRILLATION

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Atrial fibrillation (AF) is the most common supraventricular tachycardia seen in clinical practice.1 It is estimated that 6 million Americans were diagnosed with AF in 2010; this number is projected to double by the year 2050.2 Atrial flutter is less common than AF, yet the management is essentially the same. In general, the management of AF centers on rate as well as rhythm control and prevention of stroke. Table 14-1 lists risk factors for developing AF.12

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Table Graphic Jump Location
Table 14-1.Risk Factors for AF1
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Atrial Fibrillation Definitions

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  • AF—irregular heart rate, which may present as tachycardia (atrial rate of 400-600 beats per minute; ventricular rate of 120-180 beats per minute); characterized by disorganized atrial activation

  • Acute AF—onset within 48 hours

  • Paroxysmal AF—terminates spontaneously within 7 days

  • Permanent AF—does not terminate, despite therapy with drugs or electrical cardioversion

  • Persistent AF—lasts longer than 7 days and does not terminate spontaneously

  • Postoperative AF—AF that occurs 3 to 5 days after surgery; usually self-terminating

  • Recurrent AF—2 or more AF episodes

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Complications of Atrial Fibrillation

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Data suggests that Medicare patients with AF are more likely to be hospitalized than their age- and sex-matched counterparts who do not have AF.1 However, perhaps the most important complication of AF is stroke, the complications of which are listed in Table 14-2. The use of anticoagulant therapy has decreased ischemic stroke significantly over the last 20 years, but the rate of hemorrhagic stroke has remained fairly steady.1 There is some evidence to suggest that patients with AF ...

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