The committee agreed that the existing thresholds for the CHA2DS2-VASc score threshold for anticoagulation are in line with current practice. Although bleeding risk scores may occasionally be used as a reason not to offer anticoagulation, the committee agreed that they should typically be used as a prompt to identify and manage modifiable risk factors for bleeding rather than as a reason for not offering anticoagulation in people at increased risk. The committee discussed that when anticoagulation is not given because of bleeding risk, people should have regular review and reconsideration for treatment. The committee were concerned that anticoagulation is sometimes not recommended for people at risk of falls and for older people, even though age is factored into the bleeding risk score and falls are rarely a cause of major haemorrhage. Age was therefore added to the previous recommendation on people at risk of falls to ensure that anticoagulation is offered in this population when needed. The benefits and harms should be discussed with the person. How the recommendations might affect practice The recommendations are likely to lead to a change in current practice, with a reduction in warfarin use. The committee noted that this has been a prescribing trend over recent years and it may lead to a contraction in warfarin clinic services. The unit cost of direct-acting anticoagulants is greater than that for warfarin, so there is likely to be a resource impact from increased use of direct-acting anticoagulants. Return to recommendations Rate control Why the committee made the recommendations The committee made some updates to the 2014 recommendations, based on their experience and knowledge. The use of beta-blockers or rate-limiting calcium-channel blockers for initial rate-control treatment was retained by the committee because this is current practice and there was insufficient evidence to suggest an alternative option. 