This guideline covers diagnosing and managing atrial fibrillation in adults. It includes guidance on providing the best care and treatment for people with atrial fibrillation, including assessing and managing risks of stroke and bleeding.
On 30 June 2021, we amended our recommendation on using the ORBIT score to assess bleeding risk to reinstate the previous link to an appropriate calculation tool, which was removed in error on 10 June 2021.
The recommendations in this guideline were developed before the COVID-19 pandemic.
See the MHRA advice on warfarin and other anticoagulants – monitoring of patients during the COVID-19 pandemic, which includes reports of supratherapeutic anticoagulation with warfarin.
This guideline includes new and updated recommendations on:
- detection and diagnosis
- assessment of stroke and bleeding risks
- stroke prevention
- rate control
- left atrial ablation
- preventing recurrence after ablation
- preventing and managing postoperative atrial fibrillation
It also includes recommendations on:
- assessment of cardiac function
- personalised package of care and information
- rhythm control
- management of acute presentations
- initial management of stroke and atrial fibrillation
- stopping anticoagulation
Who is it for?
- Healthcare professionals
- Commissioners and providers
- People with atrial fibrillation, their families and carers
Guideline development process
This guideline was commissioned by NICE and developed in partnership with the Royal College of Physicians (RCP).
This guideline updates and replaces NICE guideline CG180 (June 2014).
The recommendations in this guideline represent the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, professionals and practitioners are expected to take this guideline fully into account, alongside the individual needs, preferences and values of their patients or the people using their service. It is not mandatory to apply the recommendations, and the guideline does not override the responsibility to make decisions appropriate to the circumstances of the individual, in consultation with them and their families and carers or guardian.
All problems (adverse events) related to a medicine or medical device used for treatment or in a procedure should be reported to the Medicines and Healthcare products Regulatory Agency using the Yellow Card Scheme.
Local commissioners and providers of healthcare have a responsibility to enable the guideline to be applied when individual professionals and people using services wish to use it. They should do so in the context of local and national priorities for funding and developing services, and in light of their duties to have due regard to the need to eliminate unlawful discrimination, to advance equality of opportunity and to reduce health inequalities. Nothing in this guideline should be interpreted in a way that would be inconsistent with complying with those duties.
Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible.