The video version of this episode can be found here:
· https://youtu.be/OnnjnhsXu4A
The video on the NICE guideline on AF on this channel that this episode is based on can be found here:
· https://youtu.be/AGdfwwzcKJs?si=G_TamzKCiQ-LW8WO
This episode makes reference to guidelines produced by the "National Institute for Health and Care Excellence" in the UK, also referred to as "NICE". The content on this channel reflects my professional interpretation/summary of the guidance and I am in no way affiliated with, employed by or funded/sponsored by NICE.
NICE stands for "National Institute for Health and Care Excellence" and is an independent organization within the UK healthcare system that produces evidence-based guidelines and recommendations to help healthcare professionals deliver the best possible care to patients, particularly within the NHS (National Health Service) by assessing new health technologies and treatments and determining their cost-effectiveness; essentially guiding best practices for patient care across the country.
My name is Fernando Florido and I am a General Practitioner in the United Kingdom. In this episode, I use AI voices to discuss CHA₂DS₂-VASc & ORBIT in AF.
I am not giving medical advice; this video is intended for health care professionals, it is only my summary and my interpretation of the guidelines and you must use your clinical judgement.
Disclaimer:
The Video Content on this channel is for educational purposes and not intended to be a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Never disregard professional medical advice or delay in seeking it because of something you have read or seen on this YouTube channel. The statements made throughout this video are not to be used or relied on to diagnose, treat, cure or prevent health conditions.
In addition, transmission of this Content is not intended to create, and receipt by you does not constitute, a physician-patient relationship with Dr Fernando Florido, his employees, agents, independent contractors, or anyone acting on behalf of Dr Fernando Florido.
There is a podcast version of this and other videos that you can access here:
Primary Care guidelines podcast:
· Redcircle: https://redcircle.com/shows/primary-care-guidelines
· Spotify: https://open.spotify.com/show/5BmqS0Ol16oQ7Kr1WYzupK
· Apple podcasts: https://podcasts.apple.com/gb/podcast/primary-care-guidelines/id1608821148
There is a YouTube version of this and other videos that you can access here:
- The Practical GP YouTube Channel:
https://youtube.com/@practicalgp?si=ecJGF5QCuMLQ6hrk
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Information
CHA₂DS₂-VASc
NICE suggest to use the CHA₂DS₂-VASc stroke risk score to assess stroke risk in people with any of the following:
- symptomatic or asymptomatic paroxysmal, persistent or permanent atrial fibrillation
- atrial flutter
- a continuing risk of arrhythmia recurrence after cardioversion back to sinus rhythm
CHA₂DS₂-VASc score for stroke risk in atrial fibrillation
Feature
Score
Congestive Heart Failure
1
Hypertension
1
Age >75 years
2
Age between 65 and 74 years
1
Stroke/TIA/TE
2
Vascular disease (previous MI, peripheral arterial disease or aortic plaque)
1
Diabetes mellitus
1
Female
1
NICE recommends
- do not offer stroke prevention therapy to people aged under 65 years with atrial fibrillation and no risk factors other than their sex (that is, very low risk of stroke equating to a CHA₂DS₂-VASc score of 0 for men or 1 for women)
- anticoagulation based on CHA₂DS₂-VASc score
- anticoagulation may be with apixaban, dabigatran etexilate, rivaroxaban or a vitamin K antagonist
- consider anticoagulation for men with a CHA₂DS₂-VASc score of 1.
- offer anticoagulation to people with a CHA₂DS₂-VASc score of 2 or above.
ORBIT
NICE have suggested that the ORBIT bleeding risk score should be used in assessing the risk of bleeding when a patient commences, or is under review, regarding anticoagulation therapy in atrial fibrillation.
NICE state that "because evidence shows that it has a higher accuracy in predicting absolute bleeding risk than other bleeding risk tools. The ORBIT bleeding risk scoring system developed a five-factor numerical bleeding risk score from the five strongest predictors termed ORBIT:
Risk Factor For Bleeding
Points Attributed
(older (75 years or older)
1 point
reduced haemoglobin (<13 mg/dL in men and <12 mg/dL in women), haematocrit (<40% in men and <36% in women) or history of anaemia
2 points
bleeding history
2 points
insufficient kidney function (eGFR < 60 mg/dL/1.73 m2)
1 point
treatment with an antiplatelet agent
1 point
ORBIT Score
Risk group
Bleeds per 100 patient-years
0-2
Low
2.4
3
Medium
4.7
4-7
High
8.1
The ORBIT risk score can provide a simple, easily remembered tool to support clinical decision making
