Atrial Fibrillation and long-term management with medication

I am 71. You have it a lot more frequently than I do. I believe there are two CHADS score systems. Aside from, the issue of gender I think one has an age cut off of 75 and another one has the cutoff at 65.

I'll pick whichever one says I don't need a blood thinner!

There are two scoring systems:
CHA2DS2-VASc
Over 75 adds 2 points, over 65 adds one point on this score: https://www.mdcalc.com/cha2ds2-vasc-score-atrial-fibrillation-stroke-risk This chart still has female gender.

CHADS2
https://www.mdcalc.com/chads2-score-atrial-fibrillation-stroke-risk This score has only 75 and does not include gender as a risk factor.

Apparently CHA2DS2-VASc supercedes CHADS2 these days so not sure why my doc said gender had been removed from consideration.

I am a two on the CHA2DS2-VASc and a one on the CHADS2. It appears it is my doc, not yours, that may be behind the times!

Hello, all.

I'm a 73 yo male -- and luckily, very healthy, though in permanent AFib for two decades. While my CHA₂DS₂-VASc score is only 1, I still chose to take an anticoagulant (no side effects for me whatsoever).

As a registered nurse, I know that these tables are designed to try to accurately predict stroke risk. I've also witnessed firsthand how a stroke can be a life-changer for some patients.

While I fully value mathematics (I have BS in engineering), we live in the real world. The best statistical predictions can't tell us exactly who's gonna end up throwing a clot, experiencing a stroke, and then not getting the prompt treatment needed to minimize brain deficits. I chose to be on the conservative side about this.

Wishing everyone the best!

Now I'm even more confused about scoring systems.

I have two thoughts, though.

1) I've read material whereby patients over 75 have their anticoagulants stopped because of their supposedly significantly elevated fall risk (which would lead to cerebral bleeding). (Some interventional EPs will OK a watchman on account of age alone.)

2) I am mystified about why no scoring system seems to
incorporate the risk of hemorrhagic stroke (one EP surgeon told me about 15% strokes are hemorrhagic. )

That being so, I'd think the guidelines for blood thinners would be more multifactorial and complex. Also that patient recommendations would be more individualized.

Apparently (read on cardiology website) AI is increased used to make diagnoses and predictions - for instance re severity of an aortic valve leakage. I can easily imagine AI doing a better job than mere humans providing recommendations about whether or not to take blood thinners .

Calling this discussion to the attention of @larrryg333 whose experience-based decision about taking anticoagulants was very interesting to me,

One thing is clear - as things stand, no model or clinician can completely eliminate stroke risk (especially since the two kinds of stroke carry opposite recommendations re prophylaxis and treatment.)

Larry is absolutely right about one aspect to recovery from either type stroke - how intense and immediate rehab is makes an enormous difference in how well and indeed if, a patient overcomes deficits. We have so little control of that, though. Care of the aged is already so terribly sub-par!

My mother is on Coumadin and I see the side effects. She has vascular dementia which I imagine may be worsened by high INR's. She has nosebleeds, large bruises, hematoma, and, most seriously, a gastric bleed that has resulted in severe anemia.

A doc took her off for 5 days without bridging her, for an endoscopy, and she had a stroke on day 5- in 2012. Her afib is continuous and she has a valve issue.

If my afib becomes more frequent and the episodes longer, I will definitely consider anti-coagulation. When I turned 65 I asked the doc if I could be scored 1.1 instead of going all the way to 2 on one day, my birthday.

Knock on wood I have just gone a year without afib. I don't eat after 5 which helps.

I was very interested in the idea of a Watchman at 75 due to increased risk of falls. One doc tried to talk me into a Watchman with one episode/year!

Good luck and thanks for the info. I agree with everything you wrote and you helped me think about this.

Enjoyed the continued discussion.
Also VERY interested in the business of not eating after 5 PM. Even though I'd have to up that timetable by at least five hours being an extreme night owl (when do you go to bed?), I too have noticed late food consumption - especially excessive - is a major trigger for AFIB.

Alcohol too, and not just "excessive" amounts, but (almost) any is a trigger for me. (Hence I scarcely ever consume even just a little).

Since I'm still trying to get back to the KETO diet as getting slender definitely normalizes my lipid profile (think I mentioned my two brothers and I have an inherited lipid disorder. ).

FWIW I'm the only one not on statins and also (not a coincidence) the only one not obese. As I'm a real foodie this is hard.

Stay well!

Amanda

The anecdote about your mother's experience with anticoagulants is horrifying. Almost makes me want to just give up (as it seems to be a damned if you do, damned if you don't situation), just following what makes ME most comfortable - especially considering how variable cardio recommendations are . (Sympathies re the vascular dementia. I hear it's just awful to cope with - not so much for the patient as for family.)

BTW my (almost) regular strenuous gym workouts are absolutely critical to avoiding AFIB.

As long as it's not too late, that is. Believe it or not, my BPM mostly rises to at least 145, and often as high as 165 or so without huffing and puffing. Far above the general guideline for my age. That's doing HIIT exercise (high intensity interval training). (If I do NOT follow this regime, I get more AFIB - in fact, it was after I slacked off that I came down with that constant tachycardia! ) Clearly everyone is very different in their heart function.

Interesting!

I also avoid alcohol. I take magnesium at night and drink low sodium V-8 which is loaded with potassium, in the morning.

I also stay up late and I do get hungry! With more light I noticed that I am eating as late as 6:30. I guess I am almost doing intermittent fasting!

Your exercise is intriguing. I walk and do tai chi, maybe I should try more aerobic exercise. I am glad it helps you.

I didn't mean to be disturbing about the Coumadin. She had major GI surgery more recently and that doc bridged her properly with Luvenox (I think it was) and she was fine. The other doc basically committed malpractice. He claimed it was the PCP's job to bridge her but I don't think so.

I am not sure what is going to happen with my afib and I could be having it silently at times but docs don't think so and a 30 day monitor showed none. I have to avoid those dramatic episodes.

Being in the ICU made me feel so safe but it was kind of absurd. That hospital did such a great job though. I was so grateful they did an echo to check for clots.

I wanted to face the monitors. I was trying to do biofeedback to slow my heart. I swear it works. Hospitals have us facing away so we don't get worried about ourselves but I really wish they would let us use the numbers to kind of meditate and bring the heart rate down!

TODAY IS MY 92ND BIRTHDAY!

I HAVE BEEN OFF ELIQUIS FOR 5 WEEKS. I WAS SWITCHED TO XRELTO AND HAVE EXPERIENCED SIGNIFICANT IMPROVEMENT FROM ELKQUIS.
I STILL HAVE A-FIB BUT ASIDE FROM SOME WEAKNESS IN MY UPPER ARMS...I DON'T SEEM TO HAVE ANY PROBLEMS...MAYBE MY EVENING BLACK RUSSIAN IS HELPING.
ALL IN ALL I SEEM TO BE MANAGING WITHOUT ANY SIGNIFICANT PROBLEM..LET'S HOPE I HIT 102 (AGE NOT TEMP) AND SET A TARGET FOR OTHERS!

PKBLUFF1@GMAIL.COM

Thanks for setting the bar so high! Happy birthday and God bless!