Patient handout

Atrial fibrillation (rate / rhythm / anticoagulation)

PRODUCTION

1. Your condition

This handout is for atrial fibrillation (rate / rhythm / anticoagulation). Your care team identified this based on: palpitations / irregular pulse — esc 2024.

Other reasons your team may use this plan: ecg / monitor showing af — esc 2024; dyspnea or fatigue from rvr — acc/aha 2023; established af (titration / monitoring visit) — esc 2024 af-care.

2. Your medications

Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.

Medication	Starting dose	How	When	What it does
risk-factor modification bundle	BP <130/80; weight loss ≥10% if BMI ≥27; OSA treatment; alcohol abstinence	lifestyle	ongoing	2024 ESC AF-CARE [C] (PMID 39210723); alcohol abstinence reduced AF recurrence HR 0.55 (0.36–0.84) over 6 mo — Voskoboinik NEJM 2020 (PMID 31893513)

Plan: Integrated AF-CARE / ABC pathway — stepwise (2024 ESC AF-CARE PMID 39210723 / 2023 ACC/AHA PMID 38033089)

3. Your action plan

Use these zones to know what to do based on how you feel.

GREEN — Doing well — AC adherent, no bleed, controlled rhythm/rate

If you have:

No bleeding signs (no melena, hematemesis, hematuria, severe bruising)
No new neurologic symptoms
Rate controlled / asymptomatic

Do this:

Continue AC every day — never skip even on travel
Continue rate / rhythm med
Annual physician visit + labs
Carry medical alert / AC card

YELLOW — Caution — minor bleed, missed dose, falls, palpitations

If you have:

Easy bruising or minor nosebleed lasting >10 min
Missed AC dose >1
Falls or near-falls
New persistent palpitations or fatigue

Do this:

Resume AC at next dose; do NOT double up
Apply pressure for bleeding; ice for bruise
Schedule fall-prevention review + bone density
Call provider within 24–48 h

Call your provider if:

Bleeding does not stop with pressure within 15 min
Multiple missed doses or AC discontinuation
New symptoms (chest pain, weakness, SOB)

RED — Medical alert — major bleed or stroke symptoms

If you have:

Severe / life-threatening bleed (vomiting blood, melena, severe nosebleed, intracranial)
Sudden severe headache, vision change, slurred speech, weakness, numbness
Trauma with significant bleeding or head injury
Sudden severe palpitations + chest pain or syncope

Do this:

Call 911 / go to ED immediately
Bring AC name + last dose time + reversal agent card
Apply pressure to external bleeding while awaiting EMS
Do NOT take additional AC doses

Call your provider if:

Any red zone symptom — ED is the destination, not the office

4. When to seek emergency care

Call 911 or go to the nearest emergency room right away if you have:

AF in WPW (delta wave on baseline ECG, irregular wide-complex tachycardia) — ACC/AHA 2023(life-threatening)
AF with SBP <90 / pulmonary edema / ischemia — ACC/AHA 2023(life-threatening)
Major bleeding (Hgb drop >2, transfusion, intracranial, GI requiring hospitalization) on DOAC or warfarin — ESC 2024(life-threatening)
CHA₂DS₂-VA ≥2 with no AC prescribed — ESC 2024

5. Follow-up

Risk-factor modification (LEGACY): BP, weight, OSA screen (STOP-BANG), alcohol; vaccination

6. Sources

Guideline: 2023 ACC/AHA/ACCP/HRS AF Guideline (Joglar, PMID 38033089/38043043) + 2024 ESC/EACTS AF Guidelines (Van Gelder, PMID 39210723) — AF-CARE/ABC pathway; supplemented by RE-LY / ROCKET-AF / ARISTOTLE / ENGAGE AF-TIMI 48 / Hart 2007 meta / AFFIRM / RACE II / EAST-AFNET 4 / CASTLE-AF / CABANA / EARLY-AF / STOP-AF First / PROTECT-AF / PREVAIL / PRAGUE-17 / Voskoboinik / LOOP / STROKESTOP. DEPTH-PASS-2 2026-05-16: purged 3 stale/SUSPECTED_FABRICATION PMIDs (29668288 IMPACT-unconfirmed, 29766750 POINT-not-AF, 23900119 REDUCE-not-AF); 27797306 PIONEER-AF-PCI dropped (triple-therapy belongs to STEMI sibling). All 22 below verified via PubMed MCP get_article_metadata 2026-05-16.