Atrial fibrillation (AF) is a complex condition, extending beyond a simple rhythm abnormality.¹ It is associated with an increased risk of cognitive impairment, all-cause dementia, vascular dementia and Alzheimer’s disease.² This has been linked to silent strokes that gradually impair brain function, as well as cerebral hypoperfusion resulting from the irregular rhythm and subsequent reduction in cardiac output.² Furthermore, the persistently high mortality rates in AF patients, despite advancements in treatment modalities, underscore the importance of prioritizing primary prevention.³ 

The 2024 ESC Guidelines for the management of AF were developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS).⁴ At the recent 2024 ESC Congress, Professor Isabelle C. Van Gelder from the University Medical Centre Groningen in the Netherlands, and Professor Dipak Kotecha from the University of Birmingham in the United Kingdom, shared the key recommendation updates (table 1).⁵ 

It is increasingly evident that AF often arises from underlying risk factors and comorbidities, such as venous thromboembolism (VTE), which has been shown to increase the risk of AF by 63% (adjusted HR=1.63, 95% CI: 1.22-2.17).^1,4,6 In response, the new guidelines introduce the AF-CARE concept: Comorbidities and risk factor management, Avoiding stroke and thromboembolic events, Reducing symptoms through rate and rhythm control, and Evaluation and dynamic reassessment.^4,5 Addressing these factors from the outset is crucial for slowing AF progression and ensuring effective treatment.⁴ 

Additionally, key recommendations to enhance safety measures were introduced, with a stronger focus on patient safety in the timing of cardioversion and anticoagulation strategies.⁴ 

In summary, the new guidelines emphasize a stronger focus on patient empowerment and shared decision-making to reflect a more holistic, patient-centered approach in AF management.⁴ By shifting towards more effective management of comorbidities, this approach may reduce or eliminate AF triggers and lower the risk of complications.^1,4