While AF in itself is not life-threatening, it is a serious condition due to the possibility of blood clots forming in the heart which could lead to a stroke. Paroxysmal AF is associated with a stroke risk of 1.38 per cent a year. For persistent AF, risk is 1.83 per cent per year and permanent AF has a risk of 1.95 per cent per year.18

The core of AF management can be summarised as the integrated ABC pathway:14 
A - Anticoagulation/Avoid stroke 
B - Better symptom control 
C – Cardiovascular and comorbidity optimisation.

NICE updated it AF guidelines in April 2021 to include:19 

• using the ORBIT bleeding risk score to indicate anticoagulant need
• the role of newer anticoagulants and
• non-drug treatments (ablation) to tackle SA node irregularities. 

Stroke risk should be assessed for anyone with AF or atrial flutter, and for ongoing risk in those who have had a cardioversion back to sinus rhythm or undergone catheter ablation.

Management of comorbidities, such as hypertension or anaemia, behaviour such as excessive alcohol consumption, and concurrent medication is also emphasised.