AAFP Guidelines Bundle

Atrial Fibrillation - Pharmacological Management

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Table 2. CHA 2 DS 2 -VASc Risk Assessment Score Risk Factor Score (if present) C Congestive heart failure 1 H Hypertension 1 A Age ≥75 y 2 D Diabetes mellitus 1 S Prior stroke or TIA 2 V Vascular disease 2 A Age 65–74 y 1 Sc Sex category (female) 1 Total Score for a maximum of 10 Table 3. Treatment Based on CHADS 2 Score CHADS 2 Score Recommended Treatment Statement for Shared Decision Making 0 Do not anticoagulate • Benefit < Harm • Patients without additional risk factors for stroke most likely will benefit less from treatment with a similar risk for bleeding. 1 Options include aspirin or anticoagulation • Benefit > Harm • Patients with an additional risk factor for stroke will benefit from treatment. Aspirin can be considered for patients at an increased risk of bleeding. Choice of therapy should be based on patient preferences and bleed risk. 2–6 Recommend anticoagulation • Benefit > Harm • Patients with additional risk factors for stroke will benefit from treatment. The evidence is currently insufficient to preferentially recommend one anticoagulant over others. Choice of anticoagulant should be based on patient preferences. Dual antiplatelet and anticoagulant therapy should not be used. e CHADS 2 score is calculated by adding 1 point each for recent congestive heart failure (i.e., active within the past 100 days or documented by echocardiography), hypertension (systolic and/or diastolic), age ≥75 years, and diabetes mellitus, and adding 2 points for a history of stroke or transient ischemic attack. A score of 0–1 was designated as low risk; a score of 2–3 was designated as moderate risk; and a score of 4, 5 or 6 was designated as high risk. Treatment

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