{"id":698,"date":"2023-10-26T11:27:34","date_gmt":"2023-10-26T15:27:34","guid":{"rendered":"https:\/\/pressbooks.bccampus.ca\/rxpidresources\/chapter\/atrial-fibrillation\/"},"modified":"2023-11-11T16:45:39","modified_gmt":"2023-11-11T21:45:39","slug":"atrial-fibrillation","status":"publish","type":"chapter","link":"https:\/\/pressbooks.bccampus.ca\/rxpidresources\/chapter\/atrial-fibrillation\/","title":{"raw":"Atrial Fibrillation","rendered":"Atrial Fibrillation"},"content":{"raw":"
\r\n
In this chapter, you will find Canadian guidelines for management of [pb_glossary id=\"53\"]atrial fibrillation[\/pb_glossary]. We have also provided you with links to relevant scoring tools to determine if stroke prevention therapy should be recommended for patients (CHA\u2082DS\u2082-VASc & HAS-BLED).<\/div>\r\n<\/div>\r\n

Student Resources<\/h2>\r\nAtrial Fibrillation One Pager<\/a>\r\n\r\nArrhythmias Drug Table<\/a>\r\n

Tools<\/h1>\r\n
HAS-BLED<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nAssess risk of bleed in patients with atrial fibrillation on anticoagulant therapy (for stroke prevention).<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring tool<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nTool consists of risk factors associated with increased bleeding risk.\r\nScore ranges from 0-9 to classify patients into low to high bleed risk:\r\n
    \r\n \t
  • 0-1=low risk<\/li>\r\n \t
  • 2= moderate risk<\/li>\r\n \t
  • 3+ = high risk<\/li>\r\n<\/ul>\r\nProvides interpretation of results and recommendation on whether to start anticoagulation therapy.<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nWhen a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if anticoagulation therapy is safe to initiate (based on bleeding risk). Use your clinical judgement to assess stroke risk and bleed risk.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
CHADS2<\/sub><\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nAssess 1 year risk of stroke in patients with atrial fibrillation to guide need for anticoagulation therapy (similar to CHA\u2082DS\u2082-VASc).<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring tool<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nTool consists of risk factors associated with increased stroke risk. Score ranges from 0-6 to classify patient into low to high risk of thromboembolic event:\r\n
    \r\n \t
  • 0=low risk<\/li>\r\n \t
  • 1-2 = intermediate risk<\/li>\r\n \t
  • 3=high risk<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nWhen a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if stroke prevention therapy is necessary.\r\n\r\n*Important to compare to bleeding risk*<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a>\r\n<\/strong><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
CHA\u2082DS\u2082-VASc<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nAssess 1 year risk of stroke in patients with atrial fibrillation to guide need for anticoagulation therapy (similar to CHADS\u2082).<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nTool consists of risk factors associated with increased stroke risk.\r\nScore ranges from 0-9 to classify patient into low to high risk of thromboembolic event:\r\n
    \r\n \t
  • For males: score 0=low risk, 1=low-moderate risk & 2+ is moderate to high risk<\/li>\r\n \t
  • For females: score 1=low risk, 2=low-moderate risk & 3+ is moderate to high risk<\/li>\r\n<\/ul>\r\nProvides recommendation on whether to start anticoagulation therapy.<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nWhen a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if stroke prevention therapy is necessary.\r\n\r\n*Important to compare to bleeding risk\r\n\r\nAlthough there is no statistical difference between CHA\u2082DS\u2082-VASc and CHADS\u2082 , CHA\u2082DS\u2082-VASc is preferred.\r\n
    \r\n \t
  • Why? Incorportates more risk factors (ex. Different age ranges, sex)<\/li>\r\n<\/ul>\r\nIf a patient is considered \u201clow risk\u201d, CHA\u2082DS\u2082-VASc can better assess the need for anticoagulation (ex. Patient may have a score of 0 with CHADS\u2082 but CHA\u2082DS\u2082-VASc may be different).<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
SPARCtool<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nAssess both the risk and benefits of starting anticoagulation therapy in patients with atrial fibrillation.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring tool<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nCombination of both CHA\u2082DS\u2082-VASc (stroke risk) and HAS-BLED (bleeding risk).\r\n
    \r\n \t
  • Updated regularly (last update May 2023)<\/li>\r\n \t
  • Provides absolute and relative risk reduction with specific drug therapies<\/li>\r\n \t
  • Information presented in both table and bar graph form<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nIf 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 and risk of specific drug therapies and overall benefit.\r\n\r\nIf you are interested in the interpretation of CHA\u2082DS\u2082-VASc and HAS-BLED scores, it is best to use their individual scoring tools.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
Tisdale Risk Score for QT prolongation<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nPredicts risk of QT prolongation.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nScoring Tool<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nIncludes risk factors and provides a risk score based on the information inputted.<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nRisk 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.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>\r\n

Guidelines<\/h1>\r\n
The Canadian Cardiovascular Society Guidelines<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nGuide treatment recommendations for patients diagnosed with atrial fibrillation. Includes treatment for both acute symptoms and long term rate and rhythm control.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nCanadian Guidelines (updated frequently \u2013 last update 2020)<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\n\r\n
    \r\n \t
  • Clinical investigations of condition (risk factors, classification, signs and symptoms)<\/li>\r\n \t
  • Rate and rhythm management algorithms (acute and chronic)<\/li>\r\n \t
  • Stroke prevention treatment<\/li>\r\n \t
  • Dosing\r\n
      \r\n \t
    • Renal adjustments<\/li>\r\n \t
    • Special populations\r\n
        \r\n \t
      • Ex. Apixaban 2.5mg BID if 2+ criteria\r\n
          \r\n \t
        • 80+ years old<\/li>\r\n \t
        • 60kg of less<\/li>\r\n \t
        • SCr 133umol\/L +<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n<\/ul>\r\n<\/li>\r\n \t
        • Special considerations based on co-morbidities (ex. AF + CAD)<\/li>\r\n<\/ul>\r\n<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nThe recommended resource to guide treatment for patients diagnosed with atrial fibrillation. The flowcharts and algorithms in the pocket guide are a great tool for studying and practicum purposes. For more details and information, the full guidelines are preferred.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE (full guidelines)<\/a> - VIEW RESOURCE (pocket guidelines)<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>
Credible Meds<\/em><\/span><\/summary>\r\n\r\n\r\n\r\n\r\n\r\n\r\n\r\n
Purpose<\/strong><\/td>\r\nProvides QT drug risk.<\/td>\r\n<\/tr>\r\n
Type of Resource<\/strong><\/td>\r\nInformative resource (requires making an account)<\/td>\r\n<\/tr>\r\n
Included<\/strong><\/td>\r\nType in medication to assess the QT risk.<\/td>\r\n<\/tr>\r\n
Student Bottom Line<\/strong><\/td>\r\nWe recommend using the information on this website in addition to the Tisdale risk score tool to assess QT prolongation risk.<\/td>\r\n<\/tr>\r\n
VIEW RESOURCE<\/a><\/td>\r\n<\/tr>\r\n<\/tbody>\r\n<\/table>\r\n<\/details>","rendered":"
\n
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 (CHA\u2082DS\u2082-VASc & HAS-BLED).<\/div>\n<\/div>\n

Student Resources<\/h2>\n

Atrial Fibrillation One Pager<\/a><\/p>\n

Arrhythmias Drug Table<\/a><\/p>\n

Tools<\/h1>\n
\nHAS-BLED<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nAssess risk of bleed in patients with atrial fibrillation on anticoagulant therapy (for stroke prevention).<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring tool<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nTool consists of risk factors associated with increased bleeding risk.
\nScore ranges from 0-9 to classify patients into low to high bleed risk:<\/p>\n
    \n
  • 0-1=low risk<\/li>\n
  • 2= moderate risk<\/li>\n
  • 3+ = high risk<\/li>\n<\/ul>\n

    Provides interpretation of results and recommendation on whether to start anticoagulation therapy.<\/td>\n<\/tr>\n

Student Bottom Line<\/strong><\/td>\nWhen a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if anticoagulation therapy is safe to initiate (based on bleeding risk). Use your clinical judgement to assess stroke risk and bleed risk.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nCHADS2<\/sub><\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nAssess 1 year risk of stroke in patients with atrial fibrillation to guide need for anticoagulation therapy (similar to CHA\u2082DS\u2082-VASc).<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring tool<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nTool consists of risk factors associated with increased stroke risk. Score ranges from 0-6 to classify patient into low to high risk of thromboembolic event:<\/p>\n
    \n
  • 0=low risk<\/li>\n
  • 1-2 = intermediate risk<\/li>\n
  • 3=high risk<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nWhen a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if stroke prevention therapy is necessary.<\/p>\n

*Important to compare to bleeding risk*<\/td>\n<\/tr>\n

VIEW RESOURCE<\/a>
\n<\/strong><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nCHA\u2082DS\u2082-VASc<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nAssess 1 year risk of stroke in patients with atrial fibrillation to guide need for anticoagulation therapy (similar to CHADS\u2082).<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nTool consists of risk factors associated with increased stroke risk.
\nScore ranges from 0-9 to classify patient into low to high risk of thromboembolic event:<\/p>\n
    \n
  • For males: score 0=low risk, 1=low-moderate risk & 2+ is moderate to high risk<\/li>\n
  • For females: score 1=low risk, 2=low-moderate risk & 3+ is moderate to high risk<\/li>\n<\/ul>\n

    Provides recommendation on whether to start anticoagulation therapy.<\/td>\n<\/tr>\n

Student Bottom Line<\/strong><\/td>\nWhen a patient is diagnosed with atrial fibrillation, use this scoring tool to determine if stroke prevention therapy is necessary.<\/p>\n

*Important to compare to bleeding risk<\/p>\n

Although there is no statistical difference between CHA\u2082DS\u2082-VASc and CHADS\u2082 , CHA\u2082DS\u2082-VASc is preferred.<\/p>\n

    \n
  • Why? Incorportates more risk factors (ex. Different age ranges, sex)<\/li>\n<\/ul>\n

    If a patient is considered \u201clow risk\u201d, CHA\u2082DS\u2082-VASc can better assess the need for anticoagulation (ex. Patient may have a score of 0 with CHADS\u2082 but CHA\u2082DS\u2082-VASc may be different).<\/td>\n<\/tr>\n

VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nSPARCtool<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nAssess both the risk and benefits of starting anticoagulation therapy in patients with atrial fibrillation.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring tool<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nCombination of both CHA\u2082DS\u2082-VASc (stroke risk) and HAS-BLED (bleeding risk).<\/p>\n
    \n
  • Updated regularly (last update May 2023)<\/li>\n
  • Provides absolute and relative risk reduction with specific drug therapies<\/li>\n
  • Information presented in both table and bar graph form<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nIf 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 and risk of specific drug therapies and overall benefit.<\/p>\n

If you are interested in the interpretation of CHA\u2082DS\u2082-VASc and HAS-BLED scores, it is best to use their individual scoring tools.<\/td>\n<\/tr>\n

VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nTisdale Risk Score for QT prolongation<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nPredicts risk of QT prolongation.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nScoring Tool<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nIncludes risk factors and provides a risk score based on the information inputted.<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nRisk 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.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n

Guidelines<\/h1>\n
\nThe Canadian Cardiovascular Society Guidelines<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nGuide treatment recommendations for patients diagnosed with atrial fibrillation. Includes treatment for both acute symptoms and long term rate and rhythm control.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nCanadian Guidelines (updated frequently \u2013 last update 2020)<\/td>\n<\/tr>\n
Included<\/strong><\/td>\n\n
    \n
  • Clinical investigations of condition (risk factors, classification, signs and symptoms)<\/li>\n
  • Rate and rhythm management algorithms (acute and chronic)<\/li>\n
  • Stroke prevention treatment<\/li>\n
  • Dosing\n
      \n
    • Renal adjustments<\/li>\n
    • Special populations\n
        \n
      • Ex. Apixaban 2.5mg BID if 2+ criteria\n
          \n
        • 80+ years old<\/li>\n
        • 60kg of less<\/li>\n
        • SCr 133umol\/L +<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
        • Special considerations based on co-morbidities (ex. AF + CAD)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nThe recommended resource to guide treatment for patients diagnosed with atrial fibrillation. The flowcharts and algorithms in the pocket guide are a great tool for studying and practicum purposes. For more details and information, the full guidelines are preferred.<\/td>\n<\/tr>\n
VIEW RESOURCE (full guidelines)<\/a> – VIEW RESOURCE (pocket guidelines)<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
\nCredible Meds<\/em><\/span><\/summary>\n\n\n\n\n\n\n\n
Purpose<\/strong><\/td>\nProvides QT drug risk.<\/td>\n<\/tr>\n
Type of Resource<\/strong><\/td>\nInformative resource (requires making an account)<\/td>\n<\/tr>\n
Included<\/strong><\/td>\nType in medication to assess the QT risk.<\/td>\n<\/tr>\n
Student Bottom Line<\/strong><\/td>\nWe recommend using the information on this website in addition to the Tisdale risk score tool to assess QT prolongation risk.<\/td>\n<\/tr>\n
VIEW RESOURCE<\/a><\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<\/details>\n
definition<\/span>