Would like to have AF veterans' opinion on "13 Reasons Why CHADS-VASc May Not be the Best for Atrial Fibrillation Stroke Prevention" article

[faridaro]

Came across the above mentioned article on Chads-Vasc scoring system and would like to get others opinion on it since I am new to all this:

drjohnday.com/13-reasons-wh...

[beardy_chris]

A scoring system is a simple guideline not a definitive assessment of stroke risk. I'm certain it could be improved but probably at the cost of increased complexity. Note the last sentence in the article "If my heart ever did go out of rhythm, I would immediately get on a blood thinner." - so, despite all of the preceding stuff, his recommendation is anti-coagulation for everyone while they have AF regardless. Having started on anti-coagulation, when do you stop? I'm afraid I think this is a rather poorly thought out article but I'm not a cardiologist.

[meadfoot]

Mm, I have long wondered whether at some stage, as with most things in life, reviews should be ongoing and very often are. We review most aspects of our lives as we progress through, what worked for us at one point is reviewed and amended as a matter of course if we think about it. We change our routines, our reactions to things, our habits etc etc.

However we tend to stick with the well tried advice where our health is concerned often because it makes sense, often through fear, sometimes through habit or because we feel better and, even when we don't, and very often because our medics 'know best' which hopefully they do most of the time or at least we trust, mainly, that they do.

Each time I pop a prescribed drug I wonder if it's really the best thing for me, pills, pills and more pills et al. I hope and assume I am doing the right thing and probably I am. Today however we have access to more and more information, are generally more savvy regarding our health, better educated and in many instances unwilling to just go along with medics opinions and medics too have involved us more in our own healthcare being a partnership not a dictat. All good stuff.

I so hope the wider medical fraternity are looking at better scoring methods etc, being more discerning and asking themselves more questions before they blanket drop on us all. We have to trust and have a basis for our treatment, but it's good that chads vasc is being questioned by some medics as are many scoring, research, experiential norms as that way improvements lie.

In the interim it's business as usual for me, through taking control of who and what I am not blindly following advice if I am not comfortable with it and challenging when I feel it's needed. We are all the architects of our health to some extent, out with illnesses which hit us and appear out of our control when we have to balance medical expertise alongside research, treatment available treatments etc. Long may we survive and thrive. Have a good day all.

[secondtry in reply to meadfoot]

Perfectly put!

[BobD Volunteer]

It may not be perfect but then neither am I. Seriously it is the best we have right now but do remember that it is not AF that is the problem it is the company it keeps so looking at those factors is a pretty good guide. Personally I subscribe to the if you have AF then take an anticoagulant view.

[jennydog]

I have developed Bob's total aversion to the term "blood thinners." By the end of the article I had high blood pressure.

[Slattery]

Dr. John Day is a well respected doctor in the US. I think we need to keep our minds open to new ideas when it comes to Afib. I am off all medication, no other health problems, live a healthy life style and feel great. When I was diagnosed with Afib, I was put on meds because I am a women and my age which made me feel terrible, I did my research and changed my doctor. I am now seeing one of the top Afib doctors in Seattle who agrees with Doctor Day and took me off meds for now. I think the pharmaceutical companies are pushing anticoagulants on all Afib patients and not looking at the individual as a whole.

[doodle68]

I have read the article and am not impressed, it seems 'lazy' to me and contains vague assumptions and inaccuracies. Here are just a couple, there are more ....

[Quote 1) ''According to CHADS-VASc, all women are candidates for life-long blood thinners.'']

Really, I have never seen that suggested anywhere . According to CHADS ,if a woman has AF and co morbidities being female scores her an extra point , if she doesn't have comorbidities being a female doesn't count towards the score.

[Quote 2) ''No Credit is Given for an Ablation. Even if a catheter ablation has eliminated your atrial fibrillation, CHADS-VASc gives you no credit. Despite many studies showing that successful ablation patients have a very low risk of stroke, this scoring system ignores the evidence.'']

No one can be sure an ablation has 'eliminated' AF, there is a chance it will return and there is some evidence that damage may have taken place in the heart prior to an ablation so even after ablation the stroke risk is on going. Also an ablation does not remove all the comorbidities that appear in CHADS some of which are thought to have contributed to the AF in the first place. They can still present a threat to AF returning after an ablation.

I Have read stuff by Dr Jonn Day before and don't rate him. He is not to be confused with the excellent Dr John Mandrola .

[faridaro]

Thank you all so much for your time and and honest responses. It's good to have fellow afibbers common sense opinions even if they are diverse - love your different perspectives!