Increased resources may be needed for reassessment, but it is anticipated that this could be performed at routine follow-up appointments with a cardiologist. Return to recommendations Rate and rhythm control for people presenting acutely Why the committee made the recommendation The committee agreed that the evidence was too limited in quality and quantity to be able to specify a preferred rate-control drug for acute atrial fibrillation. Although there was some evidence that amiodarone was better than digoxin for rate control, the committee had concerns about the quality of the evidence and the short timeframe used in 1 study, which it agreed could disadvantage digoxin. In addition, there was limited evidence available for morbidity and adverse events for this comparison and no evidence identified for other drug classes. The committee highlighted that the existing recommendations gave no guidance on acute atrial fibrillation with acute decompensated heart failure. Using their expertise and experience the committee agreed that advice on the use of beta-blockers and rate- limiting calcium-channel blockers should be included because they can lead to further deterioration in people with pulmonary oedema caused by heart failure. How the recommendation might affect practice The recommendations do not constitute a change in practice, and so are unlikely to have a resource impact. Return to recommendations Preventing postoperative atrial fibrillation Why the committee made the recommendations The committee noted that the most recent studies reviewed showed no benefit from statins in reducing atrial fibrillation after cardiothoracic surgery. This contrasted with analysis of the evidence overall, which showed a small but definite benefit from statins. The committee agreed that the evidence of no effect in the newer studies was important, because these studies were larger and of higher quality than the older studies included in the analysis. 