Diagnosis and management of atrial fibrillation in primary care: a case study

Abstract

This critically reflective case study will look at a 65-year-old male presenting with dyspnoea and an incidental diagnosis of atrial fibrillation (AF) in a primary care setting. The article critically analyses the diagnosis and management of the patient, considers potential differential diagnoses, current guidelines, and areas for service improvement. The author, a trainee advanced clinical practitioner (ACP) prescriber with a paramedic background, discusses the complexity of managing AF and the need for collaboration with a general practitioner. AF is a common cardiac arrhythmia associated with a significantly increased risk of stroke. The primary focus of AF management is stroke prevention. This article delves into the pathophysiology of AF, discussing its various causes and classifications, emphasising the role of left atrial appendage (LAA) in stroke risk. The limitations of AF screening methods, especially for paroxysmal AF, are also discussed. Recent advancements in opportunistic screening, including the use of artificial intelligence (AI) and smartwatches, show promise but require further research and validation. This article explores stroke risk assessment tools like CHA2DS2VASc and ATRIA, bleeding risk assessment using HAS-BLED and ORBIT scores, as well as rhythm control in newly diagnosed AF cases. Finally, the importance of lifestyle modifications and regular patient follow-up are underscored. AF diagnosis and management are multifaceted, involving stroke prevention, rate or rhythm control, and lifestyle modifications. Technological advancements hold promise in improving early AF detection. Collaborative efforts between healthcare providers and adherence to current guidelines are crucial in achieving optimal patient outcomes, while future practice may benefit from enhanced diagnostic screening and treatment options as further research unfolds.