The 2024 ESC Guidelines for the Management of Atrial Fibrillation serve physicians well but leave a few questions unanswered: a social media-based poll of 433 European and Asian physicians

Clinical practice guidelines are intended to improve patients’ outcomes by helping clinicians make the best evidence-based decisions in a time-efficient manner. The ESC Clinical Practice Guidelines for the management of atrial fibrillation (AF), revised in 2024, provide updated recommendations for the diagnosis and management of AF.

To assess physicians’ reactions to and adoption of the 2024 guidelines for the management of AF and to identify remaining unanswered practical, clinical questions.

A 4-question poll was conducted between 4 November–4 December 2024 on the social media news feed of registered users of a closed, physician-only, social media platform. Registered platform users from 10 European and 4 Asian countries who were cardiologists, neurologists, or primary care physicians (PCPs) were asked about the importance of the new ESC guidelines for their own clinical practice, guideline topics of greatest interest, remaining uncertainties/unanswered clinical questions about AF and direct oral anticoagulant (DOAC) management, and preferred sources for clinical decision-making. Poll participation was voluntary and no financial compensation was provided to respondents. Descriptive analyses of responses were performed by speciality and by country, and responses to questions permitting multiple answers were rank ordered by proportion of respondents.

A total of 433 physicians responded to the poll (26% cardiologists, 7% neurologists, 67% PCPs). Respondents were from Spain (33%), Germany (23%), Italy (18%), France (14%), and China (6%). Nearly all respondents (91%; N=417) considered the guidelines as very important or important for their clinical practice (very important: 76% cardiologists, 48% neurologists, 57% PCPs; important: 19% cardiologists, 45% neurologists, 32% PCPs). The 3 specialties (N=344) were largely aligned in their topics of interest, with greatest interest in comorbidity/risk factor management (Figure 1a). By specialty, cardiologists were most interested in CHA2DS2-VASc vs CHA2DS2-VA, neurologists in recommended DOAC dosing, and PCPs in rate vs rhythm control. Across specialties (N=262), the most common remaining uncertainties/unanswered clinical questions were for patients who were very elderly and/or frail, have chronic kidney disease/renal impairment, or have cancer (Figure 1b). Clinical guidelines (European and local), review articles, and congress-based information (both from congress and symposia attendance) were the most useful sources of information for clinical decision-making (N=268; Figure 2).

The 2024 ESC Clinical Practice Guidelines for AF management were considered important and useful for clinical practice by almost all respondents. Of particular interest were topics related to risk factor management, symptom control, and DOAC dosing. Additional guidance would be welcome on the management of patients with AF in high-risk groups.