2024 ESC guideline on atrial fibrillation: focus on lifestyle factors

The new European Society of Cardiology guideline on atrial fibrillation puts lifestyle and management of conditions that can lead to AF right at the forefront of practice. This is the first time an international body has prioritised treatment of non-cardiac problems as a way of managing atrial fibrillation.

Those of us who specialise in treating patients with AF have long known that this problem does not occur in isolation. Atrial fibrillation generally occurs in people with typical risk factors for the condition. These include under- or over-exercise, poor cardiometabolic health, and other medical problems. Increasingly, many cardiologists feel that managing the causes of AF, rather than just managing the symptoms, is vital.

Causes of atrial fibrillation

Poorly managed blood pressure, thyroid problems, diabetes, weight issues, excess alcohol use and untreated sleep apnoea all increase atrial fibrillation. In addition, the role of exercise in causation of AF is complex. Over- under-exercise can both increase the risk of atrial fibrillation.

Each of these factors increases risk of AF by a small amount, but many patients have multiple factors. These combine to produce a much higher risk of AF over the long term.

The new guideline

Previous versions of the ESC guideline on atrial fibrillation emphasised the importance of wider lifestyle changes and management of related conditions. However, this was alongside or after other interventions such as medication and AF ablation. For the first time in 2024, the ESC guideline on atrial fibrillation prioritises the management of comorbidities. This new approach is described as AF-CARE:

C: Comorbidity and risk factor management

A: Avoid stroke and thromboembolism

R: Reduce symptoms by rate and rhythm control

E: Evaluation and dynamic reassessment

Our approach

At Kent and London Cardiology, we have been using a similar approach for some years. We work closely with specialists in sleep medicine and weight management. We aim to help our patients understand and change the drivers for their heart rhythm problems.