Comparing Guidelines for Atrial Fibrillation: Focus on Emergency Medicine

Clare L Atzema; Jafna L Cox; Christopher C Cheung; Blanca Coll-Vinent; Emelia J Benjamin; Cynthia A Jackevicius; David R Vinson

doi:10.1016/j.annemergmed.2025.10.004

Comparing Guidelines for Atrial Fibrillation: Focus on Emergency Medicine

Ann Emerg Med. 2026 Apr;87(4):435-450. doi: 10.1016/j.annemergmed.2025.10.004. Epub 2026 Jan 28.

Authors

Clare L Atzema¹, Jafna L Cox², Christopher C Cheung³, Blanca Coll-Vinent⁴, Emelia J Benjamin⁵, Cynthia A Jackevicius⁶, David R Vinson⁷

Affiliations

¹ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada. Electronic address: clare.atzema@ices.on.ca.
² Division of Cardiology, Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada; Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
³ Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Division of Cardiology, Department of Medicine, University of Toronto, Toronto, ON, Canada.
⁴ Arrhythmia Division, Spanish Society of Emergency Medicine, Madrid, Spain; Emergency Department, Unitat de Fibrillació Auricular, Hospital Clínic, Barcelona; Grup de Recerca "Urgències: processos i patologies", IDIBAPS, Barcelona, Spain.
⁵ Department of Medicine, Boston Medical Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA; Department of Epidemiology, Boston University School of Public Health, Boston, MA.
⁶ ICES (formerly known as the Institute for Clinical Evaluative Sciences), Toronto, ON, Canada; Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada; College of Pharmacy, Western University of Health Sciences, Pomona, CA; Pharmacy Department, VA Greater Los Angeles Healthcare System, Los Angeles, CA.
⁷ Department of Emergency Medicine, Kaiser Permanente Roseville Medical Center, Roseville, CA; Division of Research, Kaiser Permanente Northern California, Pleasanton, CA.

PMID: 41603838
DOI: 10.1016/j.annemergmed.2025.10.004

Abstract

The European Society of Cardiology and the American College of Cardiology/American Heart Association/American College of Clinical Pharmacy/Heart Rhythm Society both recently updated their guidelines on the management of atrial fibrillation, whereas the Canadian Cardiovascular Society/Canadian Heart Rhythm Society published their most recent guidelines in 2020. Compared with previous iterations, all three guidelines are more specific in their recommendations with respect to emergency department (ED) care. Although the principles that underpin each group's recommendations are similar, some of the details vary, which could lead to clinician confusion. In addition, no publication has compared all 3 on the care that is specific to emergency medicine, nor contextualized them with the recommendations made by 2 national emergency medicine groups. In this Concepts paper, we compare and contrast the different guidelines as they apply to the practice of emergency medicine, highlighting differences as well as the underlying rationale provided by each group. We also provide practical insights for implementation in the ED setting.

Keywords: Anticoagulants; Atrial fibrillation; Cardiac arrhythmias; Disease management; Guidelines.

Publication types

Comparative Study
Review

MeSH terms

Atrial Fibrillation* / diagnosis
Atrial Fibrillation* / therapy
Canada
Emergency Medicine* / standards
Emergency Service, Hospital / standards
Humans
Practice Guidelines as Topic*
United States