What are the recommended initial management strategies for a patient diagnosed with atrial flutter in primary care?

Initial management strategies for a patient diagnosed with atrial flutter in primary care include:

• Assess haemodynamic stability: If the patient is haemodynamically unstable, urgent referral for emergency electrical cardioversion is required.
• Rate control: For haemodynamically stable patients, initial management usually involves rate control using a standard beta-blocker or a rate-limiting calcium-channel blocker (diltiazem or verapamil), unless contraindicated.
• Anticoagulation: Assess stroke risk and consider anticoagulation based on clinical risk profiles and patient preferences to reduce thromboembolic risk.
• Referral: Arrange prompt cardiology referral if symptoms are uncontrolled despite rate control or if rhythm control strategies are considered appropriate.
• Patient education and lifestyle advice: Provide information on stroke awareness, lifestyle modifications (weight loss, smoking cessation, alcohol moderation), and support resources.

Note that rhythm control strategies, including antiarrhythmic drugs or ablation, are generally managed by specialists and may be considered if rate control is insufficient or if the patient has heart failure or other specific indications.

Calcium-channel blockers and beta-blockers are contraindicated in patients with pre-excitation syndromes (e.g., Wolff-Parkinson-White syndrome) due to risk of ventricular fibrillation, requiring specialist input.

Overall, initial management in primary care focuses on rate control, anticoagulation assessment, symptom monitoring, and timely referral for specialist management as needed.

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