NICE Guidelines? Not so nice for those scoring 0 or 1 on the CHADS matrix.

The new guidelines are to be welcomed of course but NICE still clings to its Great Contradiction.

"According to a recent study carried out by the Atrial Fibrillation Association, one in three adults is unaware of the high stroke risk caused by AF. The stark truth is that people with AF have a possible five-fold increased risk of stroke." (Professor Mark Baker, Director of the Centre for Clinical Practice at NICE)

"Offer anticoagulation to people with a CHA2DS2-VASc score of 2 or above." (NICE Guideline)

One day......ALL those diagnosed with AF will be offered proper protection from stroke. Until then, unless you or your doctor know of sound reasons why you shouldn't, demand Anticoagulation Now!

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  • I didn't realise that and if so, I totally agree with you AN. I have a CHADS score of zero, like many others, and my EP put me on anti-coags 2-3 years ago because I'm at risk of a stroke otherwise. He, unlike NICE, prefers to avoid the problem instead of waiting, then reacting !!! I now don't have AF, but everything seems to be aimed at AF, or is AF the new description of arrhythmia because it's easier to spell :-)

    To me, and I'm not medical, CHADS is a very dangerous and misleading tool, or certainly in my case it is. I know it's supposed to be a guideline, but people and doctors use it and take it at face value. Someone's probably going to say it isn't perfect, but it should be. It needs heading "Not suitable to people with arrhythmias", instead it gets the opposite and is THE tool for people with "AF".

    Koll

  • I have just looked at that CHADS thing for the first time. Answers were 'no' to everything except age and sex. Therefore every female over 65 gets a 2 and should be coagulated. ?????? That doesn't seem sensible.

    I agree with Koll.

  • Do you think you shouldn't be anticoagulated Jenny?

  • I have classic AF and am scheduled for an ablation. I feel rotten most of the time and view warfarin as my guardian angel. It didn't mention AF at all so I 'm somewhat confused. Is anti coagulation the new statin with everyone on it?

  • The Chads scoring systems are only for folk with non-rheumatic atrial fibrillation, so while whatever you looked at "didn't mention AF" - it's only about AF. Glad to hear you're on an anticoagulant - whatever your score - it is most certainly a guardian angel.

  • What does 'non rheumatic' Afib mean I've never heard of that one.?.

    I am under 55, male with no other heart complications, no anti coagulant needed.

  • Plain old AF - not associated with rheumatic heart disease. No anti-coagulant needed? Up to you of course but I have a similar profile to you including the 5x higher risk of stroke than the general population. I wouldn't be without it.

  • Your response AN to Steve suggests that you 'share' a 5x higher risk of stroke than the general population. Steve has that alarming risk of stroke but you don't because you are properly anti-coagulated. Nice warm feeling isn't it?

  • I too have a CHADS2VACS score of zero.

    I am very very happy to be anti-coagulated, as my stroke risk remains 5 times higher than normal.

    It's your choice of course.

    My personal opinion is that I do not want to end up drooling in a corner.

    Be well

    Ian

  • I'm chads score of zero too but my EP has put me on anticoags as he said we don't want you risking any strokes in the run up to your ablation....oh joy! But sensible advice I guess!

  • I agree with you Loo53, my EP has told me that if I decide on an ablation at our next appointment then I will need to go on anti coags prior to my procedure (remember thats all it is, a procedure not an operation), this however is to prevent risk of clotting during the procedure, not to prevent any strokes and to stay on them during the healing process. However he still makes no mention of me being on them long term.

  • We're all aware of your pro-aspirin views Steve from your earlier post and against all the current advice you are, of course, perfectly entitled to hold them. And now, clots only occur during ablation procedures? Interesting.....

    Can I make a suggestion? When we both have the benefit of hindsight, let's make certain we get together 'on the other side' and have a serious debate about anti-coagulation. Mind you, you will probably have a very long wait for that discussion, as thankfully, I'm not likely to be 'going over' anytime soon. Best wishes.

  • Surely, whatever your Chads2Vacs score is, if you have AF you should be on Warfarin or one of the NOACs? My Chad score is 4 because of my age, and I am on Rivaroxaban as, unfortunately, Warfarin was not right for me. Why is there a scoring system when you have been diagnosed with AF or am I missing something.

    Just curious.

    Take care all of you.

    Di

  • You've got it in one Di.

  • 2010 - When diagnosed with AF I would have been a score of 1 because I am female.

    Prescribed warfarin & bisoporal - awaited cardio version.

    ECG checks prior to cardio version showed I was NSR - taken off warfarin & lowered bisoporal dose.

    6 weeks later had stroke.

    Not allowed to return to work - I'll health retirement.

    Read my recent posta to get full picture of where I am now - but being anti coagulated is very important - though it does minimise your risk - not remove it completely.

    Susiebelle

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