Recommendations for AF in patients with diabetes:
- Screening for AF by pulse taking or ECG is recommended in patients ≥65 years of age.
- Screening for AF by pulse taking or ECG is recommended in patients with diabetes <65 years of age (particularly when other risk factors are present).
- Systematic ECG screening should be considered to detect AF in patients aged ≥75 years, or those at high risk of stroke.
Recommendation for anticoagulation for AF in patients with diabetes:
- Oral anticoagulation is recommended for preventing stroke in patients with AF and diabetes and with at least one additional (CHA2DS2-VASc) risk factor for stroke.
- For preventing stroke in AF, nonvitamin K antagonist oral anticoagulants (NOACs) are recommended in preference to vitamin K antagonists, with the exception of patients with mechanical valve prostheses or moderate to severe mitral stenosis.
- Oral anticoagulation should be considered for preventing stroke in patients with AF and diabetes but no other CHA2DS2-VASc risk factor for stroke. This includes patients with T1DM or T2DM <65 years old.
- Use of a formal, structured, bleeding risk score (HAS-BLED score) should be considered to identify modifiable and nonmodifiable risk factors for bleeding in patients with diabetes and AF, and to identify patients in need of closer follow-up.
