Chirag Barbhaiya, MD: Updated Afib Guidelines

While many new guidelines and studies were released at the American College of Cardiology (ACC) 2019 Annual Scientific Session, one that made headlines was the updated guidelines for treatment of patients with atrial fibrillation from the ACC, the American Heart Association (AHA), and the Heart Rhythm Society (HRS). One of the most discussed of the new recommendations was the change to recommending NOACs to patients instead of warfarin.

MD Magazine® sat down with Chirag Barbhaiya, MD, cardiac electrophysiologist and assistant professor of medicine at NYU Langone Health and NYU School of Medicine, to discuss his takeaways from the guidelines and what impact they could have on primary care physicians.

MD Mag: How will the ACC/AHA/HRS updated guidelines for treating Afib impact primary care physicians?

The guidelines that came out recently that actually put NOACs or DOACs now because they're not so new the D is for direct as opposed to novel. Direct to oral anticoagulants. With them now being preferred over warfarin, I think that that makes the whole proposition of anticoagulation much more palatable.

So, it used to be that when a patient was defined as having an appropriate risk profile for Afib to be anticoagulated there was the whole introduction of the concept of the Vitamin K antagonist warfarin and what that would mean in terms of what that patient needed to do for their diet the follow up that they would need in terms of finding the right dose getting their INR checked periodically and that was arduous.

I think that contributed to a large part of the relative lack of uptake for anticoagulation the biggest and best studies that have looked at this have reported that the rates of compliance with anticoagulation among people who are appropriate for it related to Afib is on the order of 40%. So, most of the people that have Afib and should be anticoagulated aren't being anticoagulated and so now that we have the direct oral anticoagulants that don't have the interactions with medications and foods the way that warfarin did they don't require the monitoring periodically and the dose adjustment that the proposition of being anticoagulated is a little bit less daunting for patients.

It also means that for patients for physicians that are managing anticoagulation clinics the burden on the health system with regards to setting up the monitoring, figuring out the dosing, and the medical legal aspects of that have fallen away a little bit.