Latest from NICE on AF: see it on Chat GPT patients!

This video makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". Please note that the content on this channel reflects my professional interpretation/summary of the guidance and that I am in no way affiliated with, employed by or funded/sponsored by NICE.
My name is Fernando Florido and I am a GP in the United Kingdom. In today’s episode I look at the NICE guidelines: “Atrial fibrillation: diagnosis and management” (NG196), as well as the Clinical Knowledge Summaries (CKS) on diagnosis of AF and management of AF, both last updated in March 2023. I have summarised the guidance from a Primary Care perspective.
By way of disclaimer, I am not giving medical advice; this video is intended for health care professionals, it is only my interpretation of the guidelines and you must use your clinical judgement.
Tracks:
00:00 - Introduction, welcome and disclaimer
01:03 - Diagnosis of AF, CHA2DS2-VASC and ORBIT
03:58 - Management of AF
09.35 - Annual reviews of AF
13:15 - Chat GPT patient -Clinical case 1
14:53 - Chat GPT patient -Clinical case 2
17:24 - Chat GPT patient -Clinical case 3
20:33 - Chat GPT patient -Clinical case 4
23:45 - Conclusion, thank you and good-bye
There is a podcast version of this and other videos that you can access here:
Primary Care guidelines podcast:
• Redcircle: redcircle.com/shows/primary-c...
• Spotify: open.spotify.com/show/5BmqS0O...
• Apple podcasts: podcasts.apple.com/gb/podcast...
The full NICE Guideline on “Atrial fibrillation: diagnosis and management” [NG196] can be found here:
• www.nice.org.uk/guidance/ng196
Also
The Clinical Knowledge Summary on “When should I suspect atrial fibrillation and how do I confirm the diagnosis? (Last revised in March 2023) can be found here:
• cks.nice.org.uk/topics/atrial...
Also
The Clinical Knowledge Summary on “Management of AF” (Last revised in March 2023) can be found here:
• cks.nice.org.uk/topics/atrial...

[@drchinyendujokoronkwo2458]

Thanks Dr

[@practicalgp]

Thank you very much for your comment. I really appreciate it 🙏

[@medexplosion]

An excellent video as usual Doctor. Please continue the good work. You make the NICE guidelines even NICER by your clear, concise, and case-based approach. Thank you so much!

[@practicalgp]

Thank you very much for your comment. It helps a lot and I really appreciate it 🙏

[@user-bq8ws7vt2m]

Thanks Sir...feel more confident to use NICE guidelines because of the clinical scenarios and then explaining the management step by step.😊

[@practicalgp]

Thank you for your comment. I’m pleased that you’ve found it helpful. The practical scenarios are a good format to learn 👍

[@ojushealthcare5402]

Fantastic video as usual, Dr. Thanks very much!

[@practicalgp]

Thank you very much for your comment. I am pleased that you have found it useful. If there is a particular area that you would like covered, let me know.

[@ojushealthcare5402]

Thanks, Dr. I have always struggled with the trade names of inhalers in copd, asthma. While the treatment ladder is straightforward, the names like kelhale, fostair, trimbow etc make me do an online search every time. The current emphasis on green prescribing and use of DPI instead of MDI has made it more complicated. Would be great if you could do more videos matching the treatment ladder with inhalers, their components and trade names. Same applies to contraceptive pills. A video focusing on combined and mini pills, rules for barrier methods when starting and switching, explaining risks of cancers, clots rtf to patients, missed pill rules. Sorry for the long list and thanks again!

[@practicalgp]

I think it's the same for most of us. I also need to check the individual components of combination inhalers frequently. There are just too many of them. I have already started another video but I will do inhalers and contraception after that 👍

[@Sabnamparvin1992]

CAN we use CHADVASc score both for nonvalvular and valvular AF????

[@practicalgp]

Thank you for your comment. The CHA2DS2Vasc risk score is only validated in non-valvular atrial fibrillation. This is because the risk of stroke is much higher in valvular AF. It is estimated that people with nonvalvular afib are five times more likely than someone without the condition to have a stroke; those with valvular afib have a risk 17 times higher.

[@Sabnamparvin1992]

@@practicalgp so for nonvalvular AF we should use NOAC and for valvular warfarin right.

[@practicalgp]

@@Sabnamparvin1992 Yes and no. It’s a tricky question to answer because it depends on what you call “valvular AF“. The majority of DOAC trials excluded people with mechanical valves and rheumatic mitral stenosis and this is why the BNF say DOACs are licensed for non valvular AF only. But in fact many of the DOAC trials included other, perhaps less severe, valvular diseases and for them DOACs could be used.
Check this BMJ article:
www.bmj.com/content/359/bmj.j3782/rr-1#:~:text=In%20summary%2C%20patients%20with%20AF,CAN%20be%20prescribed%20NOACs%2FDOACs.
If you can’t access the article, let me know and I’ll find a way to get it to you.
If only life was simpler!
From a primary care perspective, though, I would agree with you and use DOACs only in non valvular AF. For those with valvular issues, I would start warfarin and let the cardiologist make a recommendation afterwards but I would not be surprised if some of those patients were recommended for DOACs.
By the way, I prefer to say DOAC rather than NOAC because they have been around for nearly 15 years and they are not really “new” any more 😂👍