GP Vivas · cardiovascular-health
Atrial fibrillation — structured viva
Structured oral on atrial fibrillation: defending DOAC-first anticoagulation with the landmark trials, lenient rate control, early rhythm control after EAST-AFNET 4, cardioversion rules, DOAC dosing to criteria, and the elderly patient everyone wants to under-treat.
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Target exams
RACGP CCEFRACGP oralsMRCGP SCA
Prompt
The examiner opens: 'A colleague says all this AF needs is aspirin and a beta-blocker — dismantle that sentence.' The viva branches through stroke-risk scoring, the DOAC trial evidence, rate and rhythm strategy trials, cardioversion rules and special populations.
Stem
You are the GP. A practice partner claims aspirin plus a rate-slowing drug is adequate AF care for most patients. [10]
References10ShowHide
- [1]Granger CB et al. Apixaban versus warfarin in patients with atrial fibrillation. The New England journal of medicine, 2011.PMID 21870978
- [2]Connolly SJ et al. Dabigatran versus warfarin in patients with atrial fibrillation. The New England journal of medicine, 2009.PMID 19717844
- [3]Patel MR et al. Rivaroxaban versus warfarin in nonvalvular atrial fibrillation. The New England journal of medicine, 2011.PMID 21830957
- [4]Mant J et al. Warfarin versus aspirin for stroke prevention in an elderly community population with atrial fibrillation (the Birmingham Atrial Fibrillation Treatment of the Aged Study, BAFTA): a randomised controlled trial. Lancet (London, England), 2007.PMID 17693178
- [5]Pisters R et al. A novel user-friendly score (HAS-BLED) to assess 1-year risk of major bleeding in patients with atrial fibrillation: the Euro Heart Survey. Chest, 2010.PMID 20299623
- [6]Kirchhof P et al. Early Rhythm-Control Therapy in Patients with Atrial Fibrillation. The New England journal of medicine, 2020.PMID 32865375
- [7]Wyse DG et al. A comparison of rate control and rhythm control in patients with atrial fibrillation. The New England journal of medicine, 2002.PMID 12466506
- [8]Van Gelder IC et al. Lenient versus strict rate control in patients with atrial fibrillation. The New England journal of medicine, 2010.PMID 20231232
- [9]Harrington J et al. Direct Oral Anticoagulants Versus Warfarin Across the Spectrum of Kidney Function: Patient-Level Network Meta-Analyses From COMBINE AF. Circulation, 2023.PMID 37042255
- [10]Boriani G et al. The 2024 ESC guidelines on atrial fibrillation: essential updates for everyday clinical practice. European heart journal supplements (Oxford, England), 2025.PMID 40514614