AFib and Stroke Risk Assessment With CHADS for Family Physicians

Dr. Chi-Ming Chow, MD, FRCPC Cardiologist, talks about how a Family Physician can assess stroke risk in AFib patients using the CHADS score as well as treatment options including anticoagulants.

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Dr. Chi-Ming Chow, MD, FRCPC Cardiologist, talks about how a Family Physician can assess stroke risk in AFib patients using the CHADS score as well as treatment options including anticoagulants.
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Video transcript

Featuring Dr. Chi-Ming Chow, MD, FRCPC Cardiologist

Duration: 3 minutes, 6 seconds

When you have atrial fibrillation, the risk of stroke goes up by two to four times. However, not all patients have the same risk, so each of them has to be individualized, assessed and to see if it merits being put on an anticoagulant.

We use a tool called CCS65 in Canada. The way we do it is, if the patient is about 65, anticoagulants in general is recommended. If they are less than 65, then we have to assess whether they have one or more risk factors that are pertaining to the CHADS risk factors, including congestive heart failure, hypertension, diabetes, as well as having a history of stroke or TIA.

If there are no other CHADS risk factors as mentioned, but they have a history of coronary artery disease, heart attack, stroke, or they have peripheral arterial disease, then they should be put on aspirin. If there are none of the above that were mentioned, then no aspirin or anticoagulant is needed.

If a patient needs to be put on anticoagulants, as you know there are two types of anticoagulants. Warfarin, being one of the longest in history that we have used over the last 30 to 40 years, but as many of us know, the chance of actually bleeding is much higher. We also have to check the blood, especially the iron now, quite frequently, and also there are potential interactions with many foods as well as medication. So it becomes quite challenging to use Warfarin.

With the NOACs, the novel oral anticoagulants, the interactions with foods as well as drugs are less frequent, and also they can be taken either once a day or twice a day. And also the chance of having a fatal bleed or intracranial bleed is also much less as well.

For patients with atrial fibrillation, apart from controlling the symptoms, as well as making sure the stroke risk is assessed and reduced, it’s also important to remind them to have a good, healthy lifestyle. It’s important to eat healthily, as well as maintaining a healthy weight. And it’s also to assess how much alcohol they take. Often for males we should recommend them to be less than two drinks a day. For female we should be less than one drink a day. And also it’s important for them to quit smoking as well.

If any of your patients have atrial fibrillation, it’s important for you to assess them regarding the symptoms, the risk of a stroke, and also maybe worthwhile having them assessed by a cardiologist regarding some of the potential risk factors that led to atrial fibrillation and also be considered for the appropriate anticoagulant medication.

Presenter: Dr. Chi-Ming Chow, Cardiologist, Toronto, ON

Local Practitioners: Cardiologist

This content is for informational purposes only, and is not intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified healthcare professional with any questions you may have regarding a medical condition.