A COMPARATIVE REVIEW OF CURRENT INTERNATIONAL ATRIAL FIBRILLATION GUIDELINES FROM A PRIMARY CARE PERSPECTIVE Atrial fibrillation (AF) is the most frequent sustained arrhythmia globally with significant morbidity and mortality. A local guideline has been created to help physicians in clinical decision-making by outlining various generally accepted approaches for the diagnosis, management and prevention of AF. This guideline was published 10 years ago, and it is imperative that new guidelines based on the latest consensus be renewed. Since then, various clinical guidelines have been issued in the past 5 years to standardise the management of AF, including the American College of Cardiology, European Society of Cardiology, National Institute for Health and Care Excellence and Asia Pacific Heart Rhythm Society guidelines. This review aims to provide a comprehensive comparison of these guidelines across multiple aspects of clinical management, including management frameworks, screening, anticoagulation, stroke and bleeding risk assessments, rate and rhythm control, follow-up, comorbidity management and technology usage.

Background & Objectives: The burden of stroke is increasing, in part due to increasing prevalence of diabetes mellitus. Given the high prevalence of diabetes in the Malaysian population (22.6%), we aimed to determine the prevalence of diabetes in our stroke population. We also aimed to study the stroke subtype associated with diabetes. We hypothesized that lacunar infarction would be more prevalent in diabetics. Methods: We retrospectively reviewed data of consecutive patients with acute ischaemic stroke admitted from October 2004 to December 2010 from our stroke registry. Demographic data, risk factors profile and stroke subtypes were reviewed and analyzed. Results: Eight hundred and fifty eight patients were identified from the registry. As high as 59.3% (n=509) of our patients were diabetics, of which 49.2% (n=422) had pre-existing diabetes and 10.1% (n=87) were newly diagnosed. Lacunar infarction was the commonest stroke subtype, comprising 60.6% (n=519) of all strokes. Diabetes was significantly associated with lacunar infarction (OR 1.5, CI 95% 1.16-2.01, p=0.003), particularly in those aged ≤ 55 years (OR 2.29, 95% CI 1.12-4.67) and HbA1C ≥ 6.5% (χ²=8.77, p=0.003). Conclusions: The prevalence of diabetes in our stroke patients is amongst the highest reported. Diabetes mellitus, particularly those with poor glycaemic control is strongly associated with lacunar infarction.
Diabetes Mellitus ; Stroke