Heart Health

Early rhythm control

Applies whatever the score Always

Recommendationaf-rhythm-controlNo one has reached this rule yet

Consider early rhythm control, especially within a year of diagnosis

Clinical review

All reviewers

No clinician has signed off this rule yet. It reflects our reading of the guidelines cited below, which has not been independently checked.

What someone who reaches this rule is told

Word for word, as generated for the example person below. Figures in the text are theirs.

  • Reasonable to do

    Ask about rhythm control early rather than assuming rate control is the default — especially within the first year of diagnosis.

    Proven in trialsTrials counted real events, like heart attacks, strokes, or deaths, and this changed them.

    ACC/AHAClass 2aLevel B-R
    Why, and the source

    The older teaching was that keeping the rate down is as good as restoring normal rhythm. EAST-AFNET 4 changed that for recently diagnosed AF: starting rhythm control — antiarrhythmic drugs or ablation — within about a year of diagnosis reduced cardiovascular death, stroke, and hospitalization compared with usual care. Catheter ablation is more effective than drugs at maintaining rhythm, and more so in younger patients and in heart failure with a reduced ejection fraction, where it improves outcomes rather than just symptoms.

    Where the guidelines stand

    ACC/AHA (US)

    2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation · Class 2a · Level B-R

An example person who reaches it

“Atrial fibrillation, blood thinner not yet discussed” — an illustrative profile, not a real user.

77-year-old womanBP 142/86 on medicationLDL 130diabetes, A1c 6.8%atrial fibrillation, diagnosed10-yr PREVENT-ASCVD 13.2%

Their path through atrial fibrillation

  1. Atrial fibrillation?Yes
  2. How was it found? (the evidence differs)Clinically diagnosed
  3. CHA2DS2-VASc — untreated stroke risk above ~2% a year?Yes (score >=2 men / >=3 women)
  4. Applies whatever the scoreAlways
  5. Applies whatever the scoreAlways ← this rule
  6. Applies whatever the scoreAlways

Where it sits

Asked after: Atrial fibrillation

Sources

Cited by the recommendations above.

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Runs in lib/engine/afPathway.ts as af-rhythm-control.