Heart Health

Treating what drives atrial fibrillation

Applies whatever the score Always

Recommendationaf-risk-factorsNo one has reached this rule yet

Weight loss, alcohol reduction, sleep apnea treatment, blood pressure control

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.

  • Strongly recommended

    Atrial fibrillation responds to weight loss, alcohol reduction, and treating sleep apnea more than almost any other rhythm problem. This is genuinely modifiable.

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

    ACC/AHAClass 1Level B-R
    Why, and the source

    In the LEGACY study, sustained weight loss of 10% or more produced roughly a six-fold higher chance of staying free of AF, and the benefit tracked how well the weight stayed off. Cutting alcohol reduces recurrence in a dose-dependent way — this is one of the clearest alcohol-outcome relationships in cardiology. Untreated obstructive sleep apnea substantially raises the chance AF comes back after a successful ablation, which is why it is worth testing for before paying for one. Blood pressure control belongs on the same list.

    Where the guidelines stand

    ACC/AHA (US)

    2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation · Class 1 · Level B-R

Newer, not yet standard

Promising, but not in the guidelines yet.

  • Reasonable to do

    If you genuinely cannot take an anticoagulant long term, left atrial appendage closure is the established alternative — not aspirin.

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

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

    Most AF-related clots form in the left atrial appendage, and a catheter-delivered device can seal it off. It is an established option for people with a real contraindication to long-term anticoagulation rather than a preference against it, and it is a procedure with its own risks. Raise it only after the reasons for avoiding anticoagulation have been properly examined, because those reasons are often modifiable.

    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-NR

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
  6. Applies whatever the scoreAlways ← this rule

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-risk-factors.