atrial fibrillation and stroke prevention - Continuing Medical ...
atrial fibrillation and stroke prevention - Continuing Medical ... atrial fibrillation and stroke prevention - Continuing Medical ...
Essentials in Primary Care Conference Wednesday, July 31, 2013 CHADS 2 Score CHADS 2 : Risk of Stroke National Registry of Atrial Fibrillation Participants (NRAF) # Patients (n = 1733) # Strokes (n = 94) NRAF Crude Stroke Rate per 100 Patient-yrs NRAF Adjusted Stroke Rate (95% CI)† 0 120 2 1.2 1.9 (1.2-3.0) 1 463 17 2.8 2.8 (2.0-3.8) 2 523 23 3.6 4.0 (3.1-5.1) 3 337 25 6.4 5.9 (4.6-7.3) 4 220 19 8.0 8.5 (6.3-11.1) 5 65 6 7.7 12.5 (8.2-17.5) 6 5 2 44.0 18.2 (10.5-27.4) Scoring: 1 point: Congestive heart failure, HTN, > 75 years, and DM 2 points: History of stroke or transient ischemic attack † Expected stroke rate per 100 pt-yrs, assuming aspirin not being taken Gage BF, et al. JAMA. 2001 Jun 13;285(22):2864-70. AF Rx as Per CHADS 2 Score: AT9 (2012) CHADS 2 Rx 0 1 >2 No Rx (2B) Oral Anticoagulant (1B) Oral Anticoagulant (1A) If patient chooses treatment, then ASA 81-325 mg/d (2B) If patient unwilling or unsuitable, then ASA + clopidogrel (2B) If patient unwilling or unsuitable, then ASA + clopidogrel (1B) You JJ, et al. CHEST 2012;141(2)(Suppl):e531S-e575S Jan Basile, MD Atrial Fibrillation & Stroke Prevention
Essentials in Primary Care Conference Wednesday, July 31, 2013 CHADS 2 Limitations • CHF: independent predictive role inconsistent • HTN: stroke risk may vary with degree or method of HTN control • AGE: even at age 65, risk increases • GENDER: risk in women > men and women not accounted for • VASCULOPATHY: MI, PAD, AORTIC PLAQUE associated with increased stroke risk You JJ, et al. CHEST 2012;141(2)(Suppl):e531S-e575S CHA 2 DS 2 -VASc-Total Points 9 2009 Birmingham England Schema Expressed as a Point-Based Scoring System Risk Factor Score Congestive heart failure/LV dysfunction 1 Hypertension 1 Age 75 y 2 Diabetes mellitus 1 Stroke/TIA/TE 2 Vascular disease (prior myocardial infarction, peripheral artery disease, or aortic plaque) Age 65-74 y 1 Sex category (i.e. female gender) LV = left ventricular; TE = thromboembolism How different from CHADS2 score 1 1 Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Chest. 2010 Feb;137(2):263-72. Jan Basile, MD Atrial Fibrillation & Stroke Prevention
- Page 1 and 2: Essentials in Primary Care Conferen
- Page 3 and 4: Essentials in Primary Care Conferen
- Page 5 and 6: Essentials in Primary Care Conferen
- Page 7 and 8: Essentials in Primary Care Conferen
- Page 9 and 10: Essentials in Primary Care Conferen
- Page 11 and 12: Essentials in Primary Care Conferen
- Page 13 and 14: Essentials in Primary Care Conferen
- Page 15 and 16: Essentials in Primary Care Conferen
- Page 17: Essentials in Primary Care Conferen
- Page 21 and 22: Essentials in Primary Care Conferen
- Page 23 and 24: Essentials in Primary Care Conferen
- Page 25 and 26: Essentials in Primary Care Conferen
- Page 27 and 28: Essentials in Primary Care Conferen
- Page 29 and 30: Essentials in Primary Care Conferen
- Page 31 and 32: Essentials in Primary Care Conferen
- Page 33 and 34: Essentials in Primary Care Conferen
- Page 35 and 36: Essentials in Primary Care Conferen
- Page 37 and 38: Essentials in Primary Care Conferen
- Page 39 and 40: Essentials in Primary Care Conferen
- Page 41 and 42: Essentials in Primary Care Conferen
- Page 43 and 44: Essentials in Primary Care Conferen
Essentials in Primary Care Conference<br />
Wednesday, July 31, 2013<br />
CHADS 2<br />
Score<br />
CHADS 2 : Risk of Stroke<br />
National Registry of Atrial Fibrillation Participants (NRAF)<br />
# Patients<br />
(n = 1733)<br />
# Strokes<br />
(n = 94)<br />
NRAF Crude<br />
Stroke Rate per<br />
100 Patient-yrs<br />
NRAF Adjusted<br />
Stroke Rate<br />
(95% CI)†<br />
0 120 2 1.2 1.9 (1.2-3.0)<br />
1 463 17 2.8 2.8 (2.0-3.8)<br />
2 523 23 3.6 4.0 (3.1-5.1)<br />
3 337 25 6.4 5.9 (4.6-7.3)<br />
4 220 19 8.0 8.5 (6.3-11.1)<br />
5 65 6 7.7 12.5 (8.2-17.5)<br />
6 5 2 44.0 18.2 (10.5-27.4)<br />
Scoring:<br />
1 point: Congestive heart failure, HTN, > 75 years, <strong>and</strong> DM<br />
2 points: History of <strong>stroke</strong> or transient ischemic attack<br />
† Expected <strong>stroke</strong> rate per 100 pt-yrs, assuming aspirin not being taken<br />
Gage BF, et al. JAMA. 2001 Jun 13;285(22):2864-70.<br />
AF Rx as Per CHADS 2 Score:<br />
AT9 (2012)<br />
CHADS 2<br />
Rx<br />
0<br />
1<br />
>2<br />
No Rx (2B)<br />
Oral Anticoagulant<br />
(1B)<br />
Oral Anticoagulant<br />
(1A)<br />
If patient chooses treatment,<br />
then ASA 81-325 mg/d (2B)<br />
If patient unwilling or unsuitable, then<br />
ASA + clopidogrel (2B)<br />
If patient unwilling or unsuitable, then<br />
ASA + clopidogrel (1B)<br />
You JJ, et al. CHEST 2012;141(2)(Suppl):e531S-e575S<br />
Jan Basile, MD<br />
Atrial Fibrillation & Stroke Prevention
Change language