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What about the younger patients with AFib? The prognosis for patients <60 years old, with AFib but without cardiovascular disease, appears to be similar to that in the general population. In other words, it is the underlying diseases or noncardiac causes rather than AFib that actually drives the prognosis of these patients, but obviously physicians still need to apply AFib risk stratification in order to decide when one of these patients will require administration of antithrombin therapy over the long term.
Of interest in this regard, the Figure references the practice guidelines for treatment of AFib just published in 2012 by the European Society of Cardiology.[126] These strongly recommend a practice shift toward a greater focus on identification of “truly low-risk patients with AFib” – ie, patients <65 years old with lone AFib who may not need antithrombin therapy – instead of trying to focus on identifying high-risk patients. This is an interestingly new perspective, in contrast to US emphasis on higher risk patients, but it may be an important insight that it is as important to avoid initiating long-term anticoagulation therapy in patients whose risk level may not require it because of the downside risk of bleeding.
French WJ. Am J Med 2013; 126: 00-00.
[126] Camm AJ, Lip GY, De Caterina R, et al; ESC Committee for Practice Guidelines (CPG),. 2012 focused update of the ESC guidelines for the management of atrial fibrillation: An update of the 2010 ESC Guidelines for the management of atrial fibrillation. Developed with the special contribution of the European Heart Rhythm Association. Eur Heart J. 2012;33:2719-2747.