{ "release_id": "73130c34862e2d06", "id": "cardio:guideline-acc-aha-2023-af", "owner": "cardio", "kind": "guideline", "slug": "guideline-acc-aha-2023-af", "name": "2023 ACC/AHA/ACCP/HRS atrial fibrillation guideline", "aliases": [], "atlases": [ "cardio" ], "summary_plain": "The 2023 guideline on diagnosing and managing atrial fibrillation from the American College of Cardiology and the American Heart Association, with two more societies abbreviated in its title (ACCP and HRS). Its abstract says it updates recommendations from the 2014 guideline and the 2019 focused update, and adds new ones on thromboembolic risk, anticoagulation, left atrial appendage occlusion, ablation, and risk factor modification and AF prevention. The stroke prevention points on this site come from an ACC summary because the guideline text was not read.", "summary_technical": "Circulation 2024;149(1):e1-e156, doi 10.1161/CIR.0000000000001193, PMID 38033089. Electronic publication 2023-11-30. Issued by the joint ACC/AHA committee on clinical practice guidelines. HRS has no record in this atlas. A PMC author manuscript (PMC11095842) exists but is not in the PMC Open Access subset, so it was not fetched. PubMed lists three corrections (2024-01-02, 2024-02-27 and 2024-06-11); their text was not read.", "editorial_state": "draft", "last_substantive_edit": "2026-10-15", "last_evidence_check": "2026-10-15", "next_review_due": null, "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": true }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": true }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": true } ], "navigation": { "cardio": { "system": [ "heart" ], "condition-area": [ "arrhythmias" ] } }, "payload": { "source": "cardio:acc-aha-2023-af", "issuers": [ "core:acc", "core:aha", "cardio:accp" ], "edition": "2023 guideline", "published": "2023-11-30", "planned_update": null, "status": "not_checked", "scope": null, "plain_interpretation": null }, "content_digest": "c1889f7ac7cb7e8e62228f5da230fa427ef72398689fe96526c867ea6cac71ae", "review": { "content_digest": "c1889f7ac7cb7e8e62228f5da230fa427ef72398689fe96526c867ea6cac71ae", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "claims": [ { "release_id": "73130c34862e2d06", "id": "cardio:claim-acc-aha-2023-af-risk-based-anticoagulation", "owner": "cardio", "subject_entity_id": "cardio:guideline-acc-aha-2023-af", "category": "recommendation", "statement": "An ACC summary of the 2023 ACC/AHA atrial fibrillation guideline says that for patients whose estimated yearly chance of a stroke or thromboembolic event is 2% or more, therapy to lower stroke risk should follow that thromboembolic risk, whatever the AF pattern (paroxysmal, persistent, long-standing persistent and permanent alike).", "context": { "id": "cardio:ctx-acc-aha-2023-patients-with-af", "label": "Patients with atrial fibrillation (ACC summary of the 2023 guideline)", "recipient": "unknown", "population": "Patients with atrial fibrillation. The ACC summary gives no age limits and, apart from the exceptions each claim names, no exclusions.", "care_setting": "Not stated in the ACC summary.", "geography": "Not stated in the ACC summary (issued by American societies; jurisdiction not verified)", "life_stage_note": "Not stated in the ACC summary", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (guideline context)", "eligibility": { "inclusion": [ "Patients diagnosed with atrial fibrillation" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "The source is the ACC key-perspectives summary of the guideline (ACC content, hash only), not the guideline text. The summary says stroke-reducing therapy, not oral anticoagulants by name, in this statement, so no recommendation record is written for it. It prints no class of recommendation for this statement, and it gives the treatment for lower-risk patients in text that could not be quoted. PubMed lists three corrections to the guideline (2024-01-02, 2024-02-27 and 2024-06-11); their text was not read, so it is not known whether they change anything stated here.", "editorial_state": "draft", "checked_at": "2026-10-15", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Key perspective 4, sentence 2, fragments 1 to 3", "applicability_note": "Stroke-reducing therapy follows thromboembolic risk, not AF pattern, at an annual risk of 2% or more.", "snapshot": { "id": "cardio:acc-af2023-key-perspectives-2026-10-15", "retrieved_at": "2026-10-15T13:52:56Z", "content_hash": "351ef6a153a9922b720e0ea62e3c8ccb64abd9945012b3992bb58528d3446453", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:acc-aha-2023-af", "source_type": "guideline", "title": "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines", "canonical_url": "https://doi.org/10.1161/CIR.0000000000001193", "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-01-02", "publisher": "Circulation", "edition": "Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.", "reuse_basis": "PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.", "public_text": "cite_only", "replaced_by": null, "retirement_note": null } }, { "evidence_role": "context", "locator": "CommentsCorrectionsList, three ErratumIn entries", "applicability_note": "Shows that corrections exist. What they change is unknown.", "snapshot": { "id": "cardio:pubmed-38033089-2026-10-15", "retrieved_at": "2026-10-15T13:48:58Z", "content_hash": "3ee3998a9178e8f21223e2388261924207d5e1f8fb19bf34e8355e11eb2c07a9", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:acc-aha-2023-af", "source_type": "guideline", "title": "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines", "canonical_url": "https://doi.org/10.1161/CIR.0000000000001193", "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-01-02", "publisher": "Circulation", "edition": "Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.", "reuse_basis": "PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.", "public_text": "cite_only", "replaced_by": null, "retirement_note": null } } ], "review": { "content_digest": "86b7b049b4eb4a6f17bb0749a897e0f21bc77addcb2b38bfe349373a94530c11", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/cardio--claim-acc-aha-2023-af-risk-based-anticoagulation.json" }, { "release_id": "73130c34862e2d06", "id": "cardio:claim-acc-aha-2023-af-risk-score", "owner": "cardio", "subject_entity_id": "cardio:guideline-acc-aha-2023-af", "category": "recommendation", "statement": "An ACC summary of the 2023 ACC/AHA atrial fibrillation guideline says the guideline endorses using a validated clinical risk score to estimate stroke and thromboembolism risk; it gives CHA2DS2-VASc, ATRIA and GARFIELD-AF as examples.", "context": { "id": "cardio:ctx-acc-aha-2023-patients-with-af", "label": "Patients with atrial fibrillation (ACC summary of the 2023 guideline)", "recipient": "unknown", "population": "Patients with atrial fibrillation. The ACC summary gives no age limits and, apart from the exceptions each claim names, no exclusions.", "care_setting": "Not stated in the ACC summary.", "geography": "Not stated in the ACC summary (issued by American societies; jurisdiction not verified)", "life_stage_note": "Not stated in the ACC summary", "life_stage_terms": null, "gestational_age_min_days": null, "gestational_age_max_days": null, "gestational_age_basis": null, "postnatal_age_min_days": null, "postnatal_age_max_days": null, "gestational_age_status": null, "postnatal_age_status": null, "followup_description": "Not applicable (guideline context)", "eligibility": { "inclusion": [ "Patients diagnosed with atrial fibrillation" ], "exclusion": [] } }, "evidence_stage": "guidance", "certainty": "not_assessed", "certainty_method": null, "limitations": "The source is the ACC key-perspectives summary of the guideline (ACC content, hash only), not the guideline text. The summary names three scores as examples and does not rank them. It gives no class of recommendation for this statement. PubMed lists three corrections to the guideline (2024-01-02, 2024-02-27 and 2024-06-11); their text was not read, so it is not known whether they change anything stated here.", "editorial_state": "draft", "checked_at": "2026-10-15", "next_review_due": null, "valid_from": null, "valid_to": null, "citations": [ { "evidence_role": "supports", "locator": "Key perspective 3, sentence 1", "applicability_note": "A validated clinical risk score is endorsed; three examples.", "snapshot": { "id": "cardio:acc-af2023-key-perspectives-2026-10-15", "retrieved_at": "2026-10-15T13:52:56Z", "content_hash": "351ef6a153a9922b720e0ea62e3c8ccb64abd9945012b3992bb58528d3446453", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:acc-aha-2023-af", "source_type": "guideline", "title": "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines", "canonical_url": "https://doi.org/10.1161/CIR.0000000000001193", "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-01-02", "publisher": "Circulation", "edition": "Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.", "reuse_basis": "PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.", "public_text": "cite_only", "replaced_by": null, "retirement_note": null } }, { "evidence_role": "context", "locator": "CommentsCorrectionsList, three ErratumIn entries", "applicability_note": "Shows that corrections exist. What they change is unknown.", "snapshot": { "id": "cardio:pubmed-38033089-2026-10-15", "retrieved_at": "2026-10-15T13:48:58Z", "content_hash": "3ee3998a9178e8f21223e2388261924207d5e1f8fb19bf34e8355e11eb2c07a9", "source_effective_date": null, "public_archive_url": null, "source_state": "corrected" }, "source": { "id": "cardio:acc-aha-2023-af", "source_type": "guideline", "title": "2023 ACC/AHA/ACCP/HRS Guideline for the Diagnosis and Management of Atrial Fibrillation: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines", "canonical_url": "https://doi.org/10.1161/CIR.0000000000001193", "identifiers": [ { "scheme": "doi", "value": "10.1161/CIR.0000000000001193", "normalized_value": "10.1161/cir.0000000000001193", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmid", "value": "38033089", "normalized_value": "38033089", "match": "exact", "version": null, "label": null, "from_source": false }, { "scheme": "pmcid", "value": "PMC11095842", "normalized_value": "PMC11095842", "match": "exact", "version": null, "label": null, "from_source": false } ], "publication_date": "2024-01-02", "publisher": "Circulation", "edition": "Published in Circulation 149(1):e1-e156 (issue date 2024-01-02; electronic publication 2023-11-30). PubMed abstract and bibliographic data only. PMC lists an author manuscript (PMC11095842) that is not in the PMC Open Access subset, so it was not fetched. The guideline text was not read. PubMed lists 3 corrections to the guideline; their text was not read. The same source also holds a snapshot of the ACC key-perspectives summary page (dated Nov 30, 2023), an ACC summary and not the guideline text. In the page markup some less-than symbols hide the text that follows them, so only passages free of such symbols are quoted. The publisher field is the journal title as PubMed gives it.", "reuse_basis": "PubMed record and ACC page. PubMed record fetched through NCBI E-utilities on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. Bibliographic metadata and short quotations from the PubMed abstract, under 25 words each. The full text was not redistributed and the societies' reuse terms were not reviewed. ACC web page fetched with a plain Mozilla/5.0 user agent on 2026-10-15. Only the hash of the bytes is kept; nothing is committed. The ACC's reuse terms were not read, so public text is cite_only: public pages state the summary in the atlas's own words, with a citation and a link, and use no ACC wording. Quote rows are short evidence fragments for the reviewer.", "public_text": "cite_only", "replaced_by": null, "retirement_note": null } } ], "review": { "content_digest": "094659aaf890f5f5f401449a0a31c3c2c1ad9ebf2c22da0980f0db9baf42ecbe", "current": [], "conflicting": [], "stale": [], "inactive": [] }, "api_path": "api/v1/claims/cardio--claim-acc-aha-2023-af-risk-score.json" } ], "decisions": [], "milestones": [], "relationships": { "outgoing": [ { "predicate": "authored_by", "label": "Co-issuer, with the American Heart Association (title)", "clinical_claim_not_fact": false, "family": "sourced", "other_entity_id": "core:acc", "other_entity_in_atlas": true, "claim_id": null, "evidence": { "snapshot_id": "cardio:pubmed-38033089-2026-10-15", "locator": "ArticleTitle, fragment 1 of 2" }, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "authored_by", "label": "Co-issuer, with the American College of Cardiology (title)", "clinical_claim_not_fact": false, "family": "sourced", "other_entity_id": "core:aha", "other_entity_in_atlas": true, "claim_id": null, "evidence": { "snapshot_id": "cardio:pubmed-38033089-2026-10-15", "locator": "ArticleTitle, fragment 1 of 2" }, "primary": false, "role": null, "valid_from": null, "valid_to": null }, { "predicate": "authored_by", "label": "Representative of the American College of Clinical Pharmacy on the writing committee (author affiliation); the title abbreviates the college as ACCP", "clinical_claim_not_fact": false, "family": "sourced", "other_entity_id": "cardio:accp", "other_entity_in_atlas": true, "claim_id": null, "evidence": { "snapshot_id": "cardio:pubmed-38033089-2026-10-15", "locator": "AuthorList, Author affiliation (ACCP representative)" }, "primary": false, "role": null, "valid_from": null, "valid_to": null } ], "incoming": [] }, "page_path": "guidelines/guideline-acc-aha-2023-af/", "context_path": "api/v1/context/cardio--guideline-acc-aha-2023-af.md" }