The 2024 European Society of Cardiology Guidelines for Diagnosis and Management of Atrial Fibrillation: A Viewpoint from a Practicing Clinician's Perspective

Abstract

Atrial fibrillation (AF) is a complex disease requiring a multidomain and (usually) long-term management, thus posing a significant burden to patients with AF, practitioners, and healthcare system. Unlike cardiovascular conditions with a narrow referral pathway (e.g., acute coronary syndrome), AF may be first detected by a range of specialties or a general practitioner. Since timely initiated optimal management is essential for the prevention of AF-related complications, a concise, as simple as possible guidance is essential to practitioners managing AF patients, regardless of their specialty. Guideline-adherent management of patients with AF has been shown to translate to improved patient outcome compared with guideline non-adherent treatment. To facilitate guideline implementation in routine clinical practice, a good AF Guideline document should introduce only evidence-based new recommendations, while avoiding arbitrary changes which may be confusing to practitioners. Here we discuss the main changes in the 2024 European Society of Cardiology (ESC) AF Guidelines relative to the previous 2020 ESC document. There is a strong impression that scientific evidence appreciation was rather unbalanced across the sections of the 2024 ESC AF Guideline document. Whether the updates and new recommendations issued by the new guidelines will translate in high adherence in clinical practice (and hence improved prognosis of patients with AF) will need to be addressed in upcoming years.