Evaluating the Clinical Effectiveness of Treatments for Atrial Fibrillation

Atrial fibrillation, or A-fib, is the most common cardiac arrythmia, particularly in senior adults. A-fib occurs when the upper chambers of the heart beat irregularly and often rapidly—out of sync with the lower chambers. An irregular heartbeat might be dangerous, particularly in people with other health conditions like high blood pressure or diabetes.

If your at-risk patient shows signs of atrial fibrillation, you may want to intervene before their condition worsens. Treatment is crucial to prevent serious complications such as blood clots, stroke and heart failure. Treatment options encompass a variety of medications and interventions, including drugs, cardioversion and cardiac ablation.

The AMA Ed Hub makes it easy for physicians, medical students, residents, nurses and other medical professionals caring for patients with atrial fibrillation to stay up to date on the vast array of treatment options. Start with this CME course from JN Learning™ to better understand how to detect, diagnose and manage the condition. You can also add "Atrial Fibrillation" as a topic of interest on the AMA Ed Hub to get the latest on advances in treatment, recent guidelines and more.

1. Understand the comparative effectiveness of different treatment options for atrial fibrillation.

   In addition to the self-paced CME course, the AMA Ed Hub provides research articles comparing different treatment approaches to a-fib. The following are accompanied by quizzes to earn CME credit:

   1. Effect of Catheter Ablation With Vein of Marshall Ethanol Infusion vs Catheter Ablation Alone on Persistent Atrial Fibrillation

      Looking at patients with persistent atrial fibrillation, researchers found that treatment combining catheter ablation and vein of Marshall ethanol infusion showed a statistically significant reduction in recurrence—and better outcomes—in comparison to catheter ablation alone after 6 and 12 months. Keep reading to find out more about the implications for secondary outcomes such as perimetral block.

   2. Effect of Digoxin vs Bisoprolol for Heart Rate Control in Atrial Fibrillation on Patient-Reported Quality of Life

      This clinical trial found that there was no statistically significant difference in patient-reported quality of life among those with atrial fibrillation and symptoms of heart failure when using digoxin versus bisoprolol (a β-blocker) for heart rate control. Learn more about the testing scales used as well as the secondary endpoints.

   3. Clinical Effectiveness of Direct Oral Anticoagulants vs Warfarin in Older Patients With Atrial Fibrillation and Ischemic Stroke

      Until now, there was limited data behind clinical guidance recommending direct oral anticoagulants (DOACs) over warfarin—for patients with atrial fibrillation who also have ischemic stroke—and it was based exclusively on clinical trial data. Read the findings to learn more about this new real-world data, how this cohort study was set up and for more detailed study findings.

   4. Association of Rivaroxaban vs Apixaban With Major Ischemic or Hemorrhagic Events in Patients With Atrial Fibrillation

      Among adults aged 65 or older with atrial fibrillation, researchers observed positive correlation between treatment with rivaroxaban (versus apixaban) and a significantly increased risk of major ischemic and hemorrhagic events. Consider these findings as you make clinical decisions.

2. Health care providers and patients should work together to create a treatment plan for atrial fibrillation.

   Whether a patient requires medication, cardioversion, ablation or surgery for atrial fibrillation depends on that patient’s medical history, symptoms and preferences. Treatment should be individualized. The American Heart Association and StopAFib.org offer a downloadable worksheet, Partnering in Your Treatment, to help patients with atrial fibrillation collaborate with their health care provider on a treatment plan.

Learn more on this topic:

• Review of Atrial Fibrillation Treatment
• Screening for Atrial Fibrillation: USPSTF Recommendation Statement
• Efficacy and Safety Considerations With Dose-Reduced Direct Oral Anticoagulants

• Anticoagulation

  Explore the latest in dosing, safety, periprocedural management and more.

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• Stroke

  Learn how to manage transient ischemic attack (TIA) and ischemic and hemorrhagic stroke.

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• Heart Failure

  Familiarize yourself with recent guidelines and advances in the treatment of heart failure.

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