There has been a significant change in the number of patients able to access oral anticoagulant therapy after the recent update of the guidelines for atrial fibrillation (AF) patients’ management. There was a record shift in the score for stroke risk assessment from CHADS2 to CHA2DS2 – VASc, researchers say.

After evaluating data from the Outcomes for Better Informed Treatment of Atrial Fibrillation (ORBIT – AF), the researchers noted an increase in the number of patients qualified for oral anticoagulation from 71.8% to 90.8% under the College of Cardiology (ACC), American Heart Association (AHA), Heart Rhythm Society (HRS) guidelines of 2011 and 2014 respectively.

These results are very important as they do not only help understand what constitutes the score (as briefly shown below) but also helps those responsible for coming up with measures to contain and handle this condition.

What constitutes the new score?

With the new CHA2DS2 – VASc score, female sex, presence of vascular disease and age factor (65 – 74 years) are the risk factors for stroke. It also increases the weight of the risk score from 1 to 2 for AF patients over the age of 75.

The new score as the researchers put, indicates that almost every AF patient, 65 years and above and almost all women with AF would be entitled to oral anticoagulation. Under the new guidelines, 98.5% of patients over 65 years and 97.7% of women would receive explicit recommendations for the therapy.

The lead analyst Dr. Emily O’Brien of Duke Clinical Research Institute, Durham, NC, notes that almost one million more patients will benefit as per the 2014 guidelines.

Shift of scores is not a reason enough

In a contrasting statement, Dr. Margaret Fang of University of California, San Francisco contends that though stroke rates have seen a dramatic fall, there is no clear evidence that the shift of scores would lead to improvements in net clinical results. Her argument is because the updated risk score affects people with less chances of stroke risk while the new risk score has little effect on those in need of the anticoagulation. She, therefore, recommends the need to use different risk – scoring systems to compare the bleeding risks with the stroke – prevention benefits.

“It is possible that the new guideline, which recommends anticoagulation for a wider swath of the population, will result in lower stroke rates,” Fang said.

Fang agrees that the new guideline would reduce the stroke rates as it recommends anticoagulation for a larger population. She, however, warns that, this would increase the number of bleeding complications. She urges the stakeholders to take note of the strokes prevented and bleeds induced before concluding on the net clinical benefit of the new guidelines.

Patients, who get the recommendations for anticoagulation, are evaluated using SAMe-TT2R2 score in order to determine the suitable oral anticoagulant.