Are family physicians using the CHADS₂score? Is it useful for assessing risk of stroke in patients with atrial fibrillation?

Douglas Klein, Max Levine
Canadian Family Physician Médecin de Famille Canadien 2011, 57 (8): e305-9

OBJECTIVE: To assess whether family physicians are using the CHADS(2) (congestive heart failure, hypertension, age ≥ 75, diabetes mellitus, and stroke or transient ischemic attack) score in the decision to initiate warfarin therapy to prevent stroke in patients with atrial fibrillation.

DESIGN: Retrospective analysis of the medical records of patients with atrial fibrillation.

SETTING: Data were gathered from records at 3 clinics in a primary care network in Edmonton, Alta.

PARTICIPANTS: The medical records of patients with atrial fibrillation who were currently taking warfarin therapy.

MAIN OUTCOME MEASURES: Percentage of patients whose CHADS(2) scores indicated warfarin therapy for stroke prophylaxis compared with the actual percentage of patients taking warfarin therapy. Data on patients' age, number of medications, and number of comorbid conditions were also recorded.

RESULTS: Among these patients, 7% had a CHADS(2) score of 0, for which no warfarin therapy was indicated; 21% had a score of 1, for which either acetylsalicylic acid or warfarin was indicated; and 72% had a score of 2 or greater, for which warfarin therapy was indicated. About 80% of patients were taking medication to control their heart rate.

CONCLUSION: The CHADS(2) score is not being used in all cases to assess the need for warfarin therapy for preventing stroke in patients with atrial fibrillation. The CHADS(2) score might be of limited use because it is not sensitive enough to stratify patients clearly into high-, intermediate-, and low-risk groups. Although guidelines for stroke prevention should be followed, the CHADS(2) portion of the guidelines might not be the most effective way to assess patients' risk of stroke.

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