A stroke-risk score calculated at diagnosis ages with the patient. A man with atrial fibrillation who scores 1 at 64 because of hypertension scores 2 at 65, and so moves into the group where anticoagulation is clearly indicated.
New diabetes, a heart failure admission, vascular disease on imaging or a transient ischaemic attack each add points too. Many patients left off anticoagulation are simply carrying an old score.
Make recalculation part of the annual review, and record the score and the decision each time. It takes a minute and is one of the commonest missed opportunities in atrial fibrillation care.
- Recalculate the score at each annual review and after any admission
- Watch for birthdays at 65 and 75, which change the score
- Add new diabetes, heart failure, vascular disease or TIA
- Record the score and the anticoagulation decision together
Why it matters
Stroke risk in atrial fibrillation changes with age and comorbidity, so a score from diagnosis goes out of date.
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