ESC Congress 2016 - 2

FEATuREd ARTIclE Overview of the 2016 ESC Clinical Practice Guidelines Written by Toni Rizzo The European Society of Cardiology (ESC) launched four new guidelines developed by expert task forces and peer reviewers, covering atrial fibrillation (AF), cardiovascular disease (CVD) prevention, dyslipidemias, and heart failure (HF). These guidelines are updates to the 2012 versions and summarize all the available evidence on the topics, providing a valuable resource for practicing clinicians. GUIDELInES FOR THE MAnAGEMEnT OF ATRIAL FIBRILLATIOn Official Peer-Reviewed Highlights From The 2016 ESC Guidelines for the management of AF created in collaboration with European Association for Cardio-Thoracic Surgery [Kirchhof P et al. Eur Heart J. 2016; Europace 2016] were developed by the ESC Task Force for the management of AF, led by Paulus Kirchhof, MD, University of Birmingham, Birmingham, United Kingdom, and Stefano Benussi, MD, University Hospital Zurich, Zurich, Switzerland. In the last few years, substantial progress has been made in the management of patients with AF. Despite this progress, AF continues to be a major cause of sudden death, stroke, HF, and CV morbidity. The 2016 guidelines emphasize the importance of screening at-risk populations with electrocardiogram (ECG) for silent and undiagnosed AF. When suspected, AF should be documented by ECG before starting treatment. Once AF has been diagnosed, the guidelines recommend a comprehensive treatment approach covering five treatment domains: acute rate and rhythm control; management of precipitating factors; assessment of stroke risk; assessment of heart rate; and assessment of symptoms (Figure 1). To achieve the desired outcomes of treatment, the ESC recommends an integrated approach with structured organization of care and follow-up, to improve guideline adherence and reduce hospitalizations and mortality. All patients with AF should undergo clinical evaluation, ECG, and echocardiogram for underlying CV conditions and those conditions should be adequately treated. Patients need to be given individualized information and education to empower them to support AF management. The guidelines recommend proposing lifestyle changes for all patients to make their management more effective. Figure 1. The 5 Domains of Atrial Fibrillation Management Treatment Acute rate and rhythm control Desired outcome Hemodynamic stability (eg, β-blockers, cardioversion) Manage precipitating factors Lifestyle changes, treatment of underlying cardiovascular conditions Assess stroke risk Oral anticoagulation in patients at risk for stroke Assess heart rate Assess symptoms Patient benefit Rate control therapy Antiarrhythmic drugs, cardioversion, catheter ablation, AF surgery Cardiovascular risk reduction Improved life expectancy Stroke prevention Symptom improvement, preservation of LV function Improved quality of life, autonomy, social functioning Symptom improvement AF, atrial fibrillation; LV, left ventricular. Reprinted from Kirchhof P et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J. 2016. doi:10.1093/eurheartj/ehw210. By permission of Oxford University Press on behalf of the European Society of Cardiology. 2 October 2016 www.escardio.org/ESCcongressinreview http://www.escardio.org/ESCcongressinreview

Table of Contents for the Digital Edition of ESC Congress 2016