A structured reference for AF in Australian general practice. Interactive CHA₂DS₂-VA (the sexless version, AU-specific) + HAS-BLED calculator. Anticoagulation choice, rate vs rhythm control, when to refer. Source: NHFA/CSANZ 2018 AF guideline.

📋 Sources (verified June 2026):

NHFA / CSANZ Atrial Fibrillation Guideline Working Group. Brieger D, Amerena J, et al. Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ 2018;27(10):1209–1266 (open access). The single authoritative AU source for CHA₂DS₂-VA. Last checked June 2026 — remains the current AU AF guideline; no replacement published or in CSANZ's announced pipeline.
Executive summary, MJA 2018;209(8):356–362 — the readable summary version of the same guidelines.
Chin PKL, Doogue MP. Oral anticoagulation for adults with atrial fibrillation or venous thromboembolism. Aust Prescr 2025;48:161–166 — current AU DOAC review (Sept 2025): obesity (BMI > 35 or wt > 120 kg) favours apixaban/rivaroxaban; warfarin first-line for valvular AF.
NHFA & CSANZ Comprehensive Australian Clinical Guideline for Diagnosing and Managing Acute Coronary Syndromes 2025 (Feb 2025) — for AF + ACS triple-therapy stepdown.
McCallum CJ. Atrial fibrillation: an update on management. Aust Prescr 2019;42(6):186–191 — earlier post-guideline update.
Landmark trials: ARISTOTLE (apixaban), ROCKET-AF (rivaroxaban), RE-LY (dabigatran), CASTLE-AF (ablation in HFrEF), EAST-AFNET 4 (early rhythm control), LEGACY (lifestyle modification).
HAS-BLED: Pisters R et al. Chest 2010;138(5):1093–1100. Endorsed by NHFA/CSANZ 2018 for assessment of modifiable bleeding factors.
International context (not the AU standard): 2024 ESC AF guidelines introduced the AF-CARE pathway and adopted CHA₂DS₂-VA (the sexless score Australia has used since 2018). Catheter ablation upgraded to first-line rhythm control for paroxysmal AF; SGLT2i recommended in HF across all LVEF.
Confirm current PBS criteria and TGA Product Information for each DOAC at pbs.gov.au and tga.gov.au before prescribing.

Reference for registered medical professionals. Not prescribing advice. Anticoagulation decisions involve weighing stroke risk vs bleeding risk in an individual patient — not algorithm output alone.

AU-specific point: Australian guidelines use CHA₂DS₂-VA (no sex point) — not CHA₂DS₂-VASc. This standardises thresholds across men and women: anticoagulation is recommended for score ≥ 2, and considered for score = 1. International (US, EU) guidelines still use CHA₂DS₂-VASc with different sex-specific thresholds — if you use MDCalc or similar, check it's using the Australian "VA" version. This page implements the AU version per NHFA/CSANZ 2018.

Stroke and bleeding risk calculator

Tick each criterion that applies. Both scores update live. Inputs stay in your browser.

Anticoagulation choice

NHFA/CSANZ 2018: DOACs are preferred over warfarin for non-valvular AF in patients who qualify. Warfarin remains the only option in valvular AF (mechanical heart valve or moderate-severe mitral stenosis), severe renal impairment beyond DOAC limits, and a few drug-interaction scenarios.

DOAC	Standard dose	Dose reduction criteria	Renal cut-off
Apixaban (Eliquis)	5 mg BD	2.5 mg BD if ≥ 2 of: age ≥ 80, weight ≤ 60 kg, Cr ≥ 133 µmol/L	CrCl ≥ 25 (caution 15–24; not in dialysis except per specialist)
Rivaroxaban (Xarelto)	20 mg daily with food	15 mg daily if CrCl 30–49	CrCl ≥ 30 (15–29 with caution; avoid < 15)
Dabigatran (Pradaxa)	150 mg BD	110 mg BD if age ≥ 75 or moderate bleeding risk or CrCl 30–49	CrCl ≥ 30 (avoid < 30)
Warfarin	Variable, INR 2.0–3.0 target	—	Any (only option in valvular AF; only option in severe renal impairment for some)

All four PBS-listed for stroke prevention in non-valvular AF. Confirm dose against current TGA Product Information and CrCl — use Cockcroft-Gault (not eGFR/MDRD) for DOAC dose decisions.

Rate vs rhythm control

NHFA/CSANZ 2018 emphasises deciding at diagnosis and reviewing periodically. EAST-AFNET 4 (2020, post-guideline) showed early rhythm control reduces cardiovascular outcomes — favouring earlier referral for rhythm control consideration in eligible patients.

Rate control (first-line for most)

β-blocker (bisoprolol, metoprolol succinate, atenolol) — first line
Non-dihydropyridine CCB (verapamil, diltiazem) — if β-blocker contraindicated; avoid in HFrEF
Digoxin — adjunct, especially in sedentary or HF; not first-line monotherapy
Target: resting HR < 110 (lenient) or < 80 (strict, if symptomatic)

Rhythm control (selected)

Cardioversion (electrical or pharmacological) — first-line for acute symptomatic AF
Flecainide — preferred AAD if no structural heart disease (NHFA/CSANZ 2018)
Sotalol, amiodarone — alternatives; amiodarone usually specialist-initiated
Catheter ablation — consider early in symptomatic paroxysmal AF, in HFrEF (improves mortality and QoL), or after AAD failure

Workup at diagnosis

When to refer

Cardiology referral (non-urgent):

New diagnosis of AF — for echo, comprehensive workup, and rate-vs-rhythm decision
Symptomatic AF despite rate control — consider rhythm control / ablation
AF with HFrEF — early rhythm control / catheter ablation reduces mortality (CASTLE-AF)
Valvular AF (mechanical valve or moderate-severe MS) — must use warfarin
Concomitant antiplatelet (post-PCI) — anticoagulation strategy
Considering catheter ablation
Patient on warfarin with persistently labile INR — switch to DOAC if eligible

Ongoing GP follow-up

MBS billing context

Standard GP items (23, 36, 44). Chronic disease management: AF qualifies for a GPCCMP — prepare (965) and review (967), which replaced the old GPMP/TCA items from July 2025 — see CDM changes guide and care plan tips. ECG: item 11714 (trace + interpretation by the ordering GP, in-house) — or item 11707 (trace only, $22.00) if the trace is instead sent to a specialist/consultant physician for formal reporting; which one applies depends on who actually interprets it. Heart Health Check (item 699) for primary prevention only — not indicated once AF is established.

Atrial fibrillation — Australian GP reference