Most patients initially access the healthcare system through pharmacists, community health workers or primary care physicians. Following an initial assessment, the ESC guidelines propose five factors (or domains) to take into account to ensure an integrated and structured approach to care.

(1) Haemodynamic instability or limiting, severe symptoms;
(2) Presence of precipitating factors (e.g. thyrotoxicosis, sepsis, or postoperative AF) and underlying cardiovascular conditions;
(3) Stroke risk and need for anticoagulation;
(4) Heart rate and need for rate control;
(5) Symptom assessment and decision for rhythm control.

Review by an Atrial Fibrillation service or at least a referral to a cardiologist is usually required following the initial assessment in order to fully evaluate the effect of AF on the patient’s overall cardiovascular health.¹