Key Feature 3a: In an individual presenting with chronic or paroxysmal atrial fibrillation: Explore the need for anticoagulation based on the risk of stroke with the patient. Skill: Patient Centered, Clinical Reasoning Phase: Diagnosis, Treatment Key Feature 3b: In an individual presenting with chronic or paroxysmal atrial fibrillation: Periodically reassess the need for anticoagulation. Skill: Clinical Reasoning Phase: Hypothesis generation, Follow-up Key Feature 4: In patients with atrial fibrillation, when the decision has been made to use anticoagulation, institute the appropriate therapy and patient education, with a comprehensive follow-up plan. Skill: Clinical Reasoning Phase: Treatment, Follow-up Key Feature 5: In a stable patient with atrial fibrillation, identify the need for rate control. Skill: Clinical Reasoning Phase: Hypothesis generation, Treatment Key Feature 6: In a stable patient with atrial fibrillation, arrange for rhythm correction when appropriate. Skill: Clinical Reasoning, Selectivity Phase: Hypothesis generation, Treatment In a patient with atrial fibrillation, whether or not they should be anticoagulated is based on the risk for stroke versus having a serious bleed. The CHADS2-VASc risk stratification score is the standard assessment tool to assess for the risk of stroke, while the HAS-BLED risk stratifications score is the equivalent to asses for the risk of a major bleed. In realtime, I use a medical calculator app (Canadian Cardiovascular Society) to determine the risk scores for the patient in front of me to help me make a decision. It's important to have a patient-centered conversation. Although the chances of having a major bleed may be higher for the patient than the risk of stroke based on their risk stratification scores, the majority of such patients may prefer to be anticoagulated given the proportional risk for decrease in quality of life should one versus the other occur. It is important to periodically reassess the need for anticoagulation as a patient's risk of stroke, risk of sustaining a major bleed, and goals of care may change over time. The Canadian Cardiovascular Society Atrial Fibrillation Guideline recommends the following for prevention of stroke and systemic embolism:
In follow-up care of a patient who has been diagnosed with atrial fibrillation, be it paroxysmal, persistent, or permanent, the following issues should be reviewed:
The Canadian Cardiovascular Society Atrial Fibrillation Guideline recommends the following for rate control of Atrial Fibrillation:
The Canadian Cardiovascular Society Atrial Fibrillation Guideline recommends the following for rate control of Atrial Fibrillation:
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