Aim: To review current practice and application of guidelines one decade on from our first audit of a nurse-led Atrial Fibrillation (AF) clinic. Method: A dedicated nurse-led clinic was set up in 2006 to address gaps between AF practice and guidelines. A 2007 audit demonstrated closing this gap. One decade on, updated guidelines were implemented. The clinic provides both medication and lifestyle management particularly around hypertension, obesity and stroke prevention. Results: 100 new AF patient referrals were randomly selected for retrospective review. The findings were compared with our 2007 audit. Just under half (49%) of patients were under 65 years. 50% were referred with paroxysmal AF, up from 25% in 2007. More patients had undergone echo prior to their clinic review (86% vs 32% in 2007). Of 47% patients with a rate control strategy 37% required medication changes, similar to 2007. Hypertension was identified in 53% patients, compare to 62% in 2007. With greater evidence of the impact of obesity in AF patients we noticed 74% patients were overweight. 100% of patients had their stroke risk assessed and documented (CHA2DS2vasc score). 79% patients had appropriate oral anticoagulation management, with intervention required in 12% patients in 2017 in clinic, down from 30% of patients in 2007. Conclusion: A nurse-led approach to managing AF continues to close the gap between practice and guidelines. We have found that obesity is a significant comorbid condition and we have demonstrated that there has been a large increase in the appropriate use of anticoagulants likely due to the introduction of dabigatran.