information please

[marg47]

What is a CHAD score and what does it mean

[BobD Volunteer]

CHADS or even better CHADSVASC is a score system to work out your stroke risk and whether you need anticoagulation Look it up on the main AF-Association website and work your score out.

Bob

[AnticoagulateNow]

To be a little more precise, and the distinction is very important, CHADS or CHADSVASC assesses your 'ADDITIONAL' risk of stroke. Irrespective of your age, your state of health and the frequency and duration of your AF episodes you are at least 5 times more likely to have a stroke than someone of similar profile in the general population who does not have AF. Your CHADS score 'adds' to that risk.

'ADDITIONAL' risk is the important thing here because a CHADS score of zero certainly doesn't mean you have no risk of stroke. Sadly, too many folk on this forum dangerously believe it does! If you have AF, no matter how young or otherwise healthy you are, anti-coagulation should be a paramount consideration unless there are overriding reasons why you cannot take them. And if your doctor/consultant can't give you a good reason why he/she is withholding this life-saving medication from you....... then get another.

Have a happy and safe new year.

[BobD Volunteer in reply to AnticoagulateNow]

OK so maybe I was trying to get the message across quickly and let Marge do the reading. Yes AF increases your stroke risk by a factor of five regardless of how frequently or severely you have it. I tell people this all the time. We were very disappointed that the June 14 NICE guidelines did not just state that if you had AF then you should be on anticoagulation which many of us believe. We have enough trouble getting many GPs to accept the current guidelines mind you but I'm sure we will get there eventually.

Bob

[Thomps95 in reply to AnticoagulateNow]

I don't see why stroke would be a 5-fold risk except when you are in fibrillation, unless you also have other risk factors. Can anyone help me find recent research that actually observed a 5-fold *stroke risk* among individuals with lone atrial fibrillation and no other risk factors? The only studies I read did not differentiate patients with and without other risk factors - the samples mainly consisted of AFib patients in their 70s and 80s with multiple risk factors. Yet in one large scale study that did carefully distinguish people with lone atrial fibrillation and a chad score of zero, their stroke risk was identical to the age matched normal population. I do understand that avoidance of stroke is paramount - it is the last thing anyone wants - but would just be interested in looking at the most recent research on this, as there seems to be conflicting views.

[AnticoagulateNow in reply to Thomps95]

"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).

That's the man to ask but I do understand your scepticism Thomps95.

Clearly AF sufferers on anti-coagulants won't be at a 5x risk of stroke so to determine that 5 affibers have strokes for every 1 non-affiber, the study could only look at those who are not taking anticoagulants and most of those probably don't even know they have AF! I can only imagine that a retrospective investigation of a sample of stroke victims has highlighted this ratio.

Secondly, I would agree with you that there is a certain ''that makes sense'' to the notion that we are only at risk of a stroke when having AF episodes, when the blood is being 'shaken up' so to speak. Sadly though, it seems that notion is flawed. Simply having the AF condition, irrespective of frequency or duration of episodes, increases the risk of stroke - something to do with imperceptibly small changes to the atrial walls, I believe.

It would be good to have this clarified by a cardiologist - they must lurk here surely? In the meantime and until those lovely folk at the AFA put out an entirely different message, I'll keep taking the tablets!

[Thomps95 in reply to AnticoagulateNow]

Yes, I agree with your decision to continue with anticoagulants, and it's important not to split hairs too much when the biggest problem now is that many people with AFib are not even aware of stroke risk. Another point is that even if a person with lone AFib is at low risk right now, they shouldn't become too complacent because they will normally progress to a higher risk category as they age and other medical / cardiac problems emerge.

But my interest is in separating the public health messages relating to anti-coagulants from the scientific evidence on stroke risks. The two are not always aligned simply because it is better to keep health messages simple so people understand and act, rather than split hairs about individual differences in circumstances and risk category, which may obscure and weaken a simple message that could save millions of lives.

And as you say, there may be co-factors - imperceptible small changes in atrial walls - that yield their own constant increase in stroke risk regardless of whether you are actually in fibrillation or not (though such mechanisms are more speculative at this stage). Anyway, I will look into the research again and see what I can post - but again, I agree with your approach. It's best to play it safe where stroke is concerned.

[Hidden]

I've always had a CHADS score of zero and have been anti-coaged for years because my EP says I should be. And that's even though for 8 years I had no symptoms or palpitations due to a successful ablation. I ask him every year whether I should stay on AG's and he confirms that I should.

So, in my EP's opinion CHADS doesn't work for me. That could be something to do with me, but can't see why as I have no other conditions. I did see a CHADS once that said if you have ever been diagnosed with high cholesterol, then you should score that as 1. That would apply to me.

Koll

[Vony]

Despite taking some very positive things out of this forum, I do not find this forum helpful at all when it comes to discussions regarding the risk of stroke. None of us are specialists in the electrics of the heart. Yes, having AF is a risk factor for cardioembolic stroke but for many people with AF that risk is still low regardless of the increased risk factor ie.less than 2%. Warfarin carries its own risks and does NOT completely prevent strokes. I am 36 and not on anticoagulation...i have worried and fretted about this a lot, especially since joining this forum and reading some of the strong views. But at the end of the day, the people on this forum are not EPs..experts in their personal unique experiences perhaps..but not EPs. Many views on anticoagulation, i believe, are driven by absolute fear of having a stroke. It is scary. And guidelines change and change is hard to accept. Many docs in my experience can tend to overtreat to be on the safe side. This is not always in the best interests of the patient. The CHADSVASC is based on the most current and up to date research, which is scrutinised. Yes, this may change, but for me, I have to accept current evidence. I certainly do not want a lifetime of AG at 36.

My brother had a severe and dangerous internal bleed due to warfarin at the age 41 ( thankfully he is fine now after a long recovery)...there are downsides to warfarin too but it is not fair or helpful to highlight these horror stories. I am seeing my EP tomorrow and will be interested to show him this thread and ask his opinion, as I admit, I also fear stroke but have to trust in my treatment plan or anxiety will take over. I shall let you all know what he says.

[teach2learn in reply to Vony]

After speaking with my cardiologist about continuing on anticoag (Eliquis) or not, following my successful ablation, I (67-year-old female with CHAD of 3) am opting not to take anyway--and here's why: The guidelines he is using to "advise" taking the anticoagulant reveal a 2% chance of stroke without the drug and a 1.5% chance of "bleedout" with the drug. I have occasional flares of diverticulitis AND an annoying hemorrhoid, both of which--along with, say, an accident--give me a higher likelihood of the bleeding problem than the now nonexistent atrial fibrillation. It's a calculated risk, but considering past years of intermittent a-fib, then full-time a-fib for months before ablation, with no clot formed, it's worth it to me not to be on a drug that has other such possible dire consequences. But that's from my own particular body's chemistry and experience, so we each must make personal choices for all of these mortal events. HAPPY, HEALTHY NEW YEAR ALL!

[Thomps95 in reply to teach2learn]

Thank you - hearing about the various decisions and reasons has been so helpful. I too have opted not to take anti-coagulants at least for a while, first because I have very low risk for stroke - 57 year old male with a CHAD2 (and CHA2DS2-VASc) of zero - and because I did take a preventative for years and ended up with internal bleeding. Now my doctor tells me it will take several years to recover and I am on another powerful drug to address that side effect. So it's important to consider one's personal risk; the amount of reduction in stroke risk if you do take anti-coagulants (in my case, negligible if any); and the risk of complications from anti-c's (in my case, those risks were unfortunately realized).

[Hidden]

Why the bickering and disputing people's views and advice. If we manage to post here we can use the web find scholarly articles and make informed decisions. Let's all be good to each other eh?