4 CGH
In this chapter, you will find Canadian guidelines for management of atrial fibrillation. We have also provided you with links to relevant scoring tools to determine if stroke prevention therapy should be recommended for patients (CHA₂DS₂-VASc & HAS-BLED).
HAS-BLED
| What is it used for? | Assess risk of bleed for patients with atrial fibrillation on anticoagulant therapy (for stroke prevention) |
| Type of Resource? | Scoring tool |
| What is included? | Tool consists of risk factors associated with increased bleeding risk
Score ranges from 0-9 to classify patients into low to high bleed risk 0-1=low risk Provides interpretation of results and recommendation on whether to start anticoagulation therapy |
| Student Bottom Line | When a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if anticoagulation therapy is safe to initiate (based on bleeding risk) *Important to compare to stroke risk* |
CHADS₂
| What is it used for? | Assess 1 year risk of stroke in patients with atrial fibrillation to guide need for anticoagulation therapy.
*similar to CHA₂DS₂-VASc |
| Type of Resource? | Scoring tool |
| What is included? | Tool consists of risk factors associated with increased stroke risk
Scores ranges from 0-6 to classify patient into low to high risk of thromboembolic event
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| Student Bottom Line | When a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if stroke prevention therapy is necessary *Important to compare to bleeding risk* |
CHA₂DS₂-VASc
| What is it used for? | Assess 1 year risk of stroke in patients with atrial fibrillation to guide need for anticoagulation therapy *similar to CHADS₂ |
| Type of Resource? | Scoring tool |
| What is included? | Tool consists of risk factors associated with increased stroke risk Score ranges from 0-9 to classify patient into low to high risk of thromboembolic event
Provides recommendation on whether to start anticoagulation therapy |
| Student Bottom Line | When a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if stroke prevention therapy is necessary *Important to compare to bleeding risk* Clinical Pearl Although there is no statistical difference between CHA₂DS₂-VASc and CHADS₂ , CHA₂DS₂-VASc is preferred.
If a patient is considered “low risk”, CHA₂DS₂-VASc can better assess the need for anticoagulation (ex. Patient may have a score of 0 with CHADS₂ but CHA₂DS₂-VASc may be different) |
SPARCtool
| What is it used for? | Assess both the risk and benefits of starting anticoagulation therapy in patients with atrial fibrillation |
| Type of Resource? | Scoring tool |
| What is included? | Combination of both CHA₂DS₂-VASc (stroke risk) and HAS-BLED (bleeding risk)
Components
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| Student Bottom Line | If you are interested in calculating both stroke and bleed risk in AF patients, this quick and easy tool will not only calculate the scores but will also assess the benefit/risk of specific drug therapies and overall benefit
If you are interested in the interpretation of CHA₂DS₂-VASc and HAS-BLED scores, it is best to use their individual scoring tools |
Tisdale Risk Score for QT prolongation
| What is it used for? | Predicts risk of QT prolongation |
| Type of Resource? | Scoring Tool |
| What is included? | Includes risk factors and provides a risk score based on the information inputted |
| Student Bottom Line | Risk of QT prolongation is an important consideration in AF. Many medications can cause QT prolongation so this scoring tool is handy to use to assess the severity of the risk. |
The Canadian Cardiovascular Society Atrial Fibrillation Guidelines
Pocket Guideline
Full Guidelines
| What is it used for? | Guide treatment recommendations for patients diagnosed with atrial fibrillation. Includes treatment for both acute symptoms and long term rate/rhythm control. |
| Type of Resource? | Canadian Guidelines
(updated frequently – last update 2020) |
| What is included? | 1) Clinical investigations of condition (risk factors, classification, signs/symptoms)
2) Rate/Rhythm Management Algorithms (acute and chronic) 3) Stroke prevention treatment 4) Dosing
5) Special considerations based on co-morbidities (ex. AF + CAD) |
| Student Bottom Line | The recommended resource to guide treatment for patients diagnosed with atrial fibrillation. The flowcharts/ algorithms in the pocket guide are a great tool for studying and practicum purposes. For more details and information, the full guidelines are preferred. |
Credible Meds
| What is it used for? | Provides medication QT drug risk |
| Type of Resource? | Informative resource |
| What is included? | Type in medication to assess the QT risk |
| Student Bottom Line | Requires students to create an account. Would use the information provided on this website for the Tisdale risk score |
