ESC 2024 Guidelines — Atrial Fibrillation

The 2024 guideline reorganises atrial fibrillation care around the AF-CARE pathway: comorbidity and risk factor management first, avoiding stroke and thromboembolism second, reducing symptoms third, and evaluation and dynamic reassessment running through all of it. The order is not decorative — several recommendations only make sense read in that sequence.

The change that catches most candidates is on bleeding risk. Scores such as HAS-BLED are explicitly not to be used to decide for or against anticoagulation; they identify modifiable risks to treat. A question that offers "withhold anticoagulation, the bleeding score is high" is testing precisely this.

Beyond that: when antiplatelet therapy may be added to an oral anticoagulant and when it must be stopped, dose reduction in combination therapy, the role of early rhythm control, ablation as first-line therapy in selected patients, and the screening recommendations including what counts as an adequate test for sleep apnoea.