Atrial fibrillation: diagnosis and management

Update information

30 June 2021: We further corrected recommendation 1.2.2 on using the ORBIT score to assess bleeding risk to reinstate the link to the previous calculation tool, which was amended in error on 10 June. The tool includes the full criteria, including options for reduced haemoglobin and reduced haematocrit which are available once the patient's sex has been selected.

10 June 2021: We amended recommendation 1.2.2 on using the ORBIT score to assess bleeding risk so that it links to a calculation tool that includes the full list of criteria, including reduced haemoglobin, reduced haematocrit and history of anaemia. We deleted a paragraph of text from the rationale and impact section for recommendation 1.8.3 that was included incorrectly.

April 2021: We have reviewed the evidence and made new recommendations on diagnosis and assessment, assessment of stroke and bleeding risks, preventing stroke, rate and rhythm control, preventing recurrence, and preventing and managing postoperative atrial fibrillation. These recommendations are marked [2021].

Recommendations marked [2014] and [2006] last had an evidence review in 2014 and 2006 respectively. In some cases, minor changes have been made to the wording for clarity and to bring the language and style up to date, without changing the meaning.

Minor changes since publication

March 2025: We replaced technology appraisal guidance recommendations with links to the relevant guidance in the sections on direct-acting oral anticoagulant treatment options and antiarrhythmic drug therapy.

August 2023: As part of our work to make our guidance more useful and usable, we are testing out some changes to improve the way we present our guidance.

Recommendations from the following technology appraisals guidance have been brought into this guideline:

October 2021: We added a link to NICE's shared decision making guideline in recommendation 1.4.2.

ISBN: 978-1-4731-4043-1