Commissioners and providers have a responsibility to promote an environmentally sustainable health and care system and should assess and reduce the environmental impact of implementing NICE recommendations wherever possible. Contents Overview 5 Who is it for? 5 1.1 Detection and diagnosis 6 1.2 Assessment of stroke and bleeding risks 7 1.3 Assessment of cardiac function 9 1.4 Personalised package of care and information 10 1.5 Referral for specialised management 11 1.6 Stroke prevention 11 1.7 Rate and rhythm control 15 1.8 Management for people presenting acutely with atrial fibrillation 20 1.9 Initial management of stroke and atrial fibrillation 22 1.10 Preventing and managing postoperative atrial fibrillation 23 Terms used in this guideline 25 Recommendations for research 27 Key recommendations for research 27 Rationale and impact 30 Detection and diagnosis 30 Stroke risk 31 Bleeding risk 32 Stroke prevention 34 Rate control 35 Left atrial ablation 37 Preventing recurrence after ablation 38 Rate and rhythm control for people presenting acutely 40 Preventing postoperative atrial fibrillation 40 Managing atrial fibrillation after cardiothoracic surgery 41 Stopping anticoagulation 42 Finding more information and committee details 45 Update information 46 This guideline replaces CG180. This guideline is the basis of QS93. Overview This guideline covers diagnosing and managing atrial fibrillation in adults. It includes guidance on providing the best care and treatment for people with atrial fibrillation, including assessing and managing risks of stroke and bleeding. The recommendations in this guideline were developed before the COVID-19 pandemic. See the MHRA advice on warfarin and other anticoagulants monitoring of patients during the COVID-19 pandemic, which includes reports of supratherapeutic anticoagulation with warfarin. Who is it for? 