A recommendation on using the ORBIT bleeding risk score to predict bleeding risk has been updated in the amended guideline

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NICE has revised NICE Guideline 196, Atrial fibrillation: diagnosis and management, to reinstate a link to the ORBIT bleeding risk score within a recommendation to assess the risk of bleeding ahead of initiating treatment with anticoagulants. The link had been removed in error from the updated guideline published on 10 June 2021.

Atrial fibrillation (AF) is a heart condition characterised by an irregular, often abnormally rapid heart rate. In AF, the actions of the chambers of the heart become less well coordinated and the heart works less efficiently, which can put patients living with the condition at an increased risk of stroke.

Most patients with AF are prescribed anticoagulants to reduce the risk of stroke. For many people with AF, the benefits of anticoagulation outweigh the risk of bleeding; however, in people with an elevated risk of bleeding, the benefits of anticoagulation may not always outweigh bleeding risk. Therefore, careful monitoring of bleeding risk is important.

Monitoring bleeding risk as part of person-centred care

The updated guidance advocates use of the ORBIT bleeding risk score because evidence demonstrates that it has a higher accuracy in predicting absolute bleeding risk than other, similar tools. The recommendation also supports shared decision making as part of person-centred care—NICE states that: ‘Accurate knowledge of bleeding risk supports shared decision making and has practical benefits, for example, increasing patient confidence and willingness to accept treatment when risk is low and prompting discussion of risk reduction when risk is high.’

The amended guideline is intended for healthcare professionals, commissioners and providers, and people with AF and their families and carers, and includes new and updated recommendations on:

  • detection and diagnosis
  • assessment of stroke and bleeding risks
  • stroke prevention
  • rate control
  • left atrial ablation
  • preventing recurrence after ablation
  • preventing and managing postoperative AF.

NG196 also includes recommendations on:

  • assessment of cardiac function
  • personalised package of care and information
  • referral
  • rhythm control
  • management of acute presentations
  • initial management of stroke and AF
  • stopping anticoagulation.