Stroke Risk Assessment With CHADS
Studies have found that as the CHADS score increases, the annual risk of ischemic stroke increases proportionally. Patients with high CHADS scores are at significant risk for stroke: 5.9% annual risk with a score of 3; up to 18.2% annual stroke risk for patients with a score of 6.
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Dr. Atul Verma, MD, FRCPC, Cardiologist, Southlake Hospital, Toronto discusses how atrial fibrillation patients are assessed for stroke risk based on the CHADS score.
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AFib and Stroke Risk Assessment - CHADS Score
During atrial fibrillation, the chambers of the heart are not beating properly. In particular, the upper chambers of the heart which are called the atrium. They beat in a very chaotic and disorganized way. And when that happens, the blood can pool in the chamber and start to form clots.
And unfortunately, if those clots break off and go to the brain, then that is the cause of a stroke. Stroke is probably the most serious risk associated with atrial fibrillation. We know that patients who have atrial fibrillation and other risk factors can have five times the risk of stroke compared to individuals who do not have atrial fibrillation.
And the main way that we treat or prevent strokes from happening is by putting patients on blood thinners. Now, before the only option we had was Warfarin. And unfortunately, Warfarin was difficult to use. It required routine blood monitoring, doses would change, you couldn’t eat certain foods.
Now we have a whole new group of oral anticoagulants or blood thinners that are new, that are easier to use, that can be taken at fixed doses, and that don’t need any routine blood monitoring. And furthermore, they’re also associated with a decreased risk of fatal bleeding, bleeds in the brain which obviously can be very, very serious, and can be just as effective as Warfarin in preventing stroke.
We also know that even amongst patients who have atrial fibrillation, there are those who are at higher risk than others. And in fact there are certain patient characteristics, which we abbreviate with the acronym CHADS, that can highlight patients who are at the absolute highest risk of stroke, and who can benefit from blood thinning therapy.
So, CHADS stands for patients who have congestive heart failure, patients with high blood pressure, patients who are over the age of 65, patients with diabetes, or patients who have had a previous stroke. And if you have any one of these risk factors, you probably need to be on a blood thinner if you have atrial fibrillation.
Compliance is very, very important in patients with atrial fibrillation. Oftentimes, patients are on multiple therapies for their atrial fibrillation. You’re going to be on a therapy potentially for preventing stroke, like a blood thinner, but you may also be on therapies to control the rate of your atrial fibrillation, or to prevent atrial fibrillation from coming back.
If we think about the blood thinners in particular, if the drugs are not taken on a regular basis, and you skip even one or two doses of the drugs, particularly the newer blood thinners, then a lot of that blood thinning activity can wear off. And as soon as it wears off, you’re back at being at a high risk of stroke.
So it’s very important that when you’re taking one of these blood thinners, you shouldn’t be missing even one or two doses of the drug. And there are a number of lifestyle modifications that you can do as well.
For example, if you’re currently smoking, quitting smoking can substantially reduce your risk of stroke. Alcohol is also known to worsen atrial fibrillation and also increase the risk of stroke. So cutting back to no more than one standard alcoholic drink a day or preferably even no alcohol at all would be of benefit.
And then another risk factor is obesity in atrial fibrillation. So healthy eating and exercise to reduce weight is a very important thing that you can do to reduce your risk of stroke and reduce the severity of atrial fibrillation.
Often seeing a local family physician or a pharmacist in conjunction with a registered dietitian is a great option to take control of dehydration. In conjunction with healthy eating, exercise and Smart Food Now
If you’re looking for more information on atrial fibrillation, there are a number of people that you can approach. Feel free to approach your family doctor, nurse practitioner, pharmacist, or consult with a specialist, a cardiologist, for example, to find out more information on atrial fibrillation and how you can best treat this problem. Often seeing a local family physician or a pharmacist in conjunction with a registered dietitian is a great option to take control of dehydration. In conjunction with healthy eating, exercise and Smart Food Now
Presenter: Dr. Atul Verma, Electrophysiologist, Newmarket, ON
Now Health Network Local Practitioners: Electrophysiologist