There’s a big mis-conception that autovacuum is evil. Although it’s true that autovacuum can do things unexpectedly, I’ve found that it’s better to tune it up and let it do what it does best. There are always going to be large / busy / special tables that need special attention, and that’s okay.
Attached is a talk I gave at SCaLE 15x on Friday, March 3rd; I walk you through (a very rudimentary and high-level) version of why we need vacuum and then take you through a 4-step strategy that will lead you to success! See the PDF here. Many thanks to the SCaLE team and PgUs!