The CHADSVASc score for non-valvular atrial fibrillation dramatically increases the need for either warfarin or dabigatran.
01.12 - Rhythm Disorders/Sudden death (Prevention & Epidemiology)
Not Member of EACPR
M. Matangi1, DW. Armstrong1, D. Brouillard1 - (1) Kingston Heart Clinic, Kingston, Canada
Purpose. The CHADS score is widely used to determine the type of antithrombotic treatment given to patients with non-valvular atrial fibrillation. Patients with a CHADS score of 0 or 1 usually receive Aspirin, although with a CHADS score of 1 there is the option to use either Aspirin, Warfarin or Dabigatran. A CHADS score of >1 should receive Warfarin or Dabigatran. More recently the CHADSVASc score has been incorporated into the European atrial fibrillation guidelines. The CHADSVASc score has major advantages over the CHADS score. The CHADSVASc score takes into account the increased risk of both the very elderly (≥75 years) and women. These patients have an increased thromboembolic risk with non-valvular atrial fibrillation. A further advantage of the CHADSVASc score is that a score of 0 has virtually no risk of thromboembolism. Such is not the case for the CHADS score. The purpose of our study was to determine the change, if any, in antithrombotic therapy of patients with a CHADS score of 0 or 1 when recalculated using the new CHADSVASc score. Methods. Our cardiology database was searched for all patients with non-valvular atrial fibrillation who had a CHADS score of either 0 or 1. There were 206 patients. The CHADSVASc scores were then calculated for each patient. We assumed that a CHADSVASc score of 0 or 1 would receive Apririn and a score >1 would receive either Warfarin or Dabigatran. Results. Of the 206 patients, 86 had a CHADS score of 0 and 120 a CHADS score of 1. Of the 86 with a CHADS score of 0, 13 had a CHADSVASc score of 2 and 1 had a CHADSVASc score of 3. Indicating that 16.3% of patients with a CHADS score of 0 would require either Warfarin or Dabigatran based on their CHADSVASc score. Of the 120 patients with a CHADS score of 1, 61 had a CHADSVASc score of 2, 27 a CHADSVASc score of 3 and 3 a CHADSVASc score of 4. Indicating that 75.8% of patients with a CHADS score of 1 would now require Warfarin or Dabigatran. Overall 51% of patients previously given the option of treatment with Aspirin would now be treated with either Warfarin or Dabigatran. Conclusions. Our data indicate that use of the CHADSVASc score in patients with non-valvular atrial fibrillation would lead to an extra 51% of patients receiving either Warfarin or Dabigatran who would otherwise be given the option of treatment with Aspirin. Given the high percentage of CHADS 1 patients who by CHADSVASc are ≥2 (75.8%) one can make the case that physicians who continue to use the CHADS score should be advised that it would be more appropriate to treat all patients with a CHADS score of ≥1 with either Warfarin or Dabigatran.