July 13, 2026Circulation
2019 AHA/ACC/HRS Focused Update of the 2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society in Collaboration With the Society of Thoracic Surgeons
Key Points
- To present a focused update of the clinical practice guidelines for the management of atrial fibrillation.
- Expert writing group composed of leading cardiologists and heart rhythm specialists.
- Review of existing literature and clinical practices regarding atrial fibrillation management.
- Collaboration among multiple cardiovascular organizations.
- Updated recommendations on anticoagulation therapy in atrial fibrillation.
- New strategies for rhythm control and rate control management.
- Guidance on the integration of surgical options for patients with atrial fibrillation.
PICO
P
Population
Atrial Fibrillation
Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“This is a really important shift. It's recognition that female sex is not as important a risk factor [for AF-associated stroke] as once was thought. This will change the number of women with AF who go on anticoagulation. We have been struggling with the notion that all women 65 or older with AF had to be on an anticoagulant. Now a clinician has more leeway. In general, patients with AF remain underanticoagulated, but this clarifies practice and brings us in line with the European guidelines.”
“The 2014 guidelines recommended anticoagulation using the CHA2DS2-VASc scoring system, but treated warfarin and the NOACs as equivalent. But the new guidelines now are in favor of NOACs. The main reason being that there appears to be less bleeding risk with NOACs compared to warfarin, and there may or may not be a little more efficacy in stroke prevention with NOACs as well.”
“Patients with AFib are at increased risk of stroke, which can be devastating. A goal of treating AFib patients is to make blood less likely to form clots, which reduces the risk of stroke. New scientific studies show that NOACs may be safer for patients because there is less risk of bleeding, and they may also be more effective at preventing blood clots than warfarin.”
Implication
Clinicians should adopt updated anticoagulation and rhythm strategies for AF now; extends prior guidelines with integrated surgical guidance.
Abstract
Writing Group Members* Craig T. January, MD, PhD, FACC (Chair), L. Samuel Wann, MD, MACC, FAHA (Vice Chair), Hugh Calkins, MD, FACC, FAHA, FHRS,* Lin Y. Chen, MD, MS, FACC, FAHA, FHRS, Joaquin E. Cigarroa, MD, FACC, Joseph C. Cleveland Jr., MD, FACC,*,x Patrick T. Ellinor, MD, PhD,* Michael D. Ezekowitz, MBChB, DPhil, FACC, FAHA,*,k Michael E. Field, MD, FACC, FAHA, FHRS,k Karen L. Furie, MD, MPH, FAHA,k Paul A. Heidenreich, MD, FACC, FAHA,{ Katherine T. Murray, MD, FACC, FAHA, FHRS,k Julie B. Shea, MS, RNCS, FHRS,*,k Cynthia M. Tracy, MD, FAHA,k Clyde W. Yancy, MD, MACC, FAHAk
Discussion
No takes yet. Share an insight, caveat, or question.
Cite This Study
January et al. (2019) conducted a review in Atrial Fibrillation. The 2019 AHA/ACC/HRS focused update provides revised clinical practice guidelines for the management of patients with atrial fibrillation.