when to refer

When to refer?

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

when to refer

Following a diagnosis, an integrated and structured approach to AF care is seen as best practice, providing the potential to achieve the best outcomes for patients. This requires coordination and collaboration between primary care physicians, cardiologists, cardiac surgeons, AF specialists, stroke specialists, allied health practitioners and patients.

Patients should have a central role in the care process and understand their responsibilities in adhering to treatment and to any lifestyle changes required to optimize their health outcomes.

More information on this can be found in the patient centred approach section.


1. Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D et al. (2016) 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Eur Heart J 37 (38): 2893-2962.

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