Atrial fibrillation is a common cardiac arrhythmia that affects approximately 240,000 Australians. This condition presents with inefficient cardiac contractions that are associated with a seven-fold increased risk of stroke. Therefore, anticoagulation forms an important part of the management of atrial fibrillation.
Many risk stratification models have been proposed to estimate an individual’s risk of stroke. The CHA2DS2-VASc score is one such model. First introduced by the European Society of Cardiology (ESC), the CHA2DS2-VASc score is more inclusive of common stroke risk factors compared to other risk assessment models.
At the recent ESC Congress in Rome, an updated set of guidelines was released to stratify the risk of stroke for patients with atrial fibrillation. Previously, anticoagulation for patients with atrial fibrillation was considered for men with a CHA2DS2-VASc score of 1, and recommended for both men and women with a CHA2DS2-VASc score of ≥ 2.
In the updated guidelines, anticoagulation is considered for men with a CHA2DS2-VASc score of 1, or for women with a score of 2. An individualised assessment and weighing of risk factors and patient preferences should be undertaken before deciding to anticoagulate patients with only one CHA2DS2 -VASc risk factor. However, strong evidence from controlled trials now indicates that men with a CHA2DS2-VASc score of ≥ 2, or women with a score of ≥ 3, will benefit from anticoagulation.
- European Heart Rhythm Association, European Association for Cardio-Thoracic Surgery, Camm AJ, Kirchhof P, Lip GY, Schotten U, et al. Guidelines for the management of atrial fibrillation: the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology (ESC) . Eur Heart J. 2010; 31(19):2369-429.
- European Heart Rhythm Association, Kirchhof P, Benussi S, Kotecha D, Ahlsson A, Atar D, et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS: The Task Force for the management of atrial fibrillation of the European Society of Cardiology (ESC) . Eur J Cardiothorac Surg. 2016 pii: ezw313. [Epub ahead of print].
- Lindley R, Dewey H, Sindone A, Lalor E, Cadilhac D. The economic costs of atrial fibrillation in Australia . PriceWaterhouseCoopers: 2010.