Atrial fibrillation affects more than 2 million Americans. A recent update of guidelines published in 2001 provides evidence-based recommendations and algorithms for managing different types of atrial fibrillation (AF). The key points regarding drug therapy are:

1. Heart rate control may be best for older patients with hypertension or heart disease, whereas younger patients, particularly those with paroxysmal lone AF, may benefit from heart rhythm control.

2. Decisions about anticoagulation therapy should be based on the patient's stroke risk, rather than on whether sinus rhythm is maintained.

3. The basic recommendations for antithrombotic therapy in AF are aspirin for patients without stroke risk factors, aspirin or warfarin for patients with 1 moderate risk factor, and warfarin for patients with any high risk factor or more than 1 moderate risk factor.

High risk factors for stroke include previous stroke, transient ischemic attack, or embolism; mitral stenosis; and a prosthetic heart valve. Moderate risk factors include age >75 years, hypertension, heart failure, ejection fraction <35%, and diabetes.

Dr. Garrett is a clinical pharmacist practitioner at Cornerstone Health Care in High Point, NC.