Key Points
Question How have the American Heart Association/American College of Cardiology/Heart Rhythm Society clinical practice guidelines on atrial fibrillation changed over time with respect to the distribution of recommendations across classes of recommendations and levels of evidence?
Findings This review of guideline recommendations found that despite a significant increase in atrial fibrillation research from 2001 to 2014, there was a nonsignificant increase in the use of level B evidence, an insignificant decrease in the use of level C evidence, and the use of level A evidence did not appreciably change. The 2014 guideline was largely supported by level C evidence with few level A recommendations (8.8%); no rate control recommendations were supported by level A evidence.
Meaning Significant opportunities exist to improve the evidence base on the management of atrial fibrillation, specifically within rate control.
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