What is a Family Physician
Family medicine is a specialty that focuses on comprehensive primary care of people of all ages. Having a long-lasting relationship with a family doctor who knows your history is greatly beneficial. A family physician can diagnose and treat all types of diseases, and if necessary, refer you to a specialist like a cardiologist . Seniors will account for 22 percent of the population by 2050. Many seniors live active and healthy lives, but as we age, our health needs change. These changes depend on different factors, such as your genetics (family history) and lifestyle modifications.Heart Failure Now
Local Family Physician
AFib and Stroke Risk Assessment With CHADS for Family Physicians
When you have atrial fibrillation, the risk of stroke goes up by two to four times. However, not all patients have the same risk, so each of them has to be individualized, assessed and to see if it merits being put on an anticoagulant.
We use a tool called CCS65 in Canada. The way we do it is, if the patient is about 65, anticoagulants in general is recommended. If they are less than 65, then we have to assess whether they have one or more risk factors that are pertaining to the CHADS risk factors, including congestive heart failure, hypertension, diabetes, as well as having a history of stroke or TIA.
If there are no other CHADS risk factors as mentioned, but they have a history of coronary artery disease, heart attack, stroke, or they have peripheral arterial disease, then they should be put on aspirin. If there are none of the above that were mentioned, then no aspirin or anticoagulant is needed.
If a patient needs to be put on anticoagulants, as you know there are two types of anticoagulants. Warfarin, being one of the longest in history that we have used over the last 30 to 40 years, but as many of us know, the chance of actually bleeding is much higher. We also have to check the blood, especially the iron now, quite frequently, and also there are potential interactions with many foods as well as medication. So it becomes quite challenging to use Warfarin.
With the NOACs, the novel oral anticoagulants, the interactions with foods as well as drugs are less frequent, and also they can be taken either once a day or twice a day. And also the chance of having a fatal bleed or intracranial bleed is also much less as well.
For patients with atrial fibrillation, apart from controlling the symptoms, as well as making sure the stroke risk is assessed and reduced, it’s also important to remind them to have a good, healthy lifestyle. It’s important to eat healthily, as well as maintaining a healthy weight. And it’s also to assess how much alcohol they take. Often for males we should recommend them to be less than two drinks a day. For female we should be less than one drink a day. And also it’s important for them to quit smoking as well.
If any of your patients have atrial fibrillation, it’s important for you to assess them regarding the symptoms, the risk of a stroke, and also maybe worthwhile having them assessed by a cardiologist regarding some of the potential risk factors that led to atrial fibrillation and also be considered for the appropriate anticoagulant medication. Local Cardiologist.
Presenter: Dr. Chi-Ming Chow, Cardiologist, Toronto, ON
Local Practitioners: Cardiologist