Risk assessments Flashcards
What is the QRISK3 score used for?
Estimate the risk of developing a heart attack or stroke over the next 10 years
What information is used in a QRISK3 score?
Patient information:
- age
- sex
- ethnicity
- smoking status
- angina/MI in 1st degree relative < 60
Comorbidities:
- diabetes
- CKD (stage 3, 4, or, 5)
- AF
- migraines
- rheumatoid arthritis
- SLE
- severe mental illness
- erectile dysfunction
Medication:
- regular steroid
- blood pressure treatment
- atypical antipsychotic medication
Others:
- cholesterol/HDL ratio
- systolic blood pressure
- height & weight
How are patients with a QRISK3 score of less than 10% managed?
- Advise that their risk is low
- Offer relevant lifestyle factors
- Review relevant comorbidities
- Reassess in 5 years
How are patients with a QRISK3 score of more than 10% managed?
- Exclude familial hypercholesterolaemia and other causes of secondary dyslipidaemia
- Discuss the benefits of lifestyle modifications and optimal management of comorbidities
- Offer statin treatment if lifestyle modification is ineffective/inappropriate
- atorvastatin 20mg OD
What is a ABCD2 score used for?
Estimates the risk of stroke after a suspected TIA
What information is used in an ABCD2 score?
A - age > 60
B - BP > 140/90
C - clinical features of TIA: speech disturbance without weakness, or unilateral weakness
D - duration of symptoms: 10-59 mins, or >60 mins
D - diabetes
What do the ABCD2 scores mean?
1-3 = Low risk
- 2-day stroke risk = 1%
- 90-day stroke risk = 3%
4-5 = Moderate risk
- 2-day stroke risk = 4%
- 90-day stroke risk = 10%
6-7 = High risk
- 2-day stroke risk = 8%
- 90-day stroke risk = 18%
How does an ABCD2 score affect management?
High risk:
- dual antiplatelet therapy (aspirin 300mg + DOAC) should be started as soon as haemorrhage is ruled out
- admit patient for evaluation by neurologist/further imaging
Low risk:
- give aspirin 300mg
- refer to specialist and evaluate as an outpatient
What is a CHA2DS2-VASc score used for?
Estimating the risk of stroke of other thromboembolic event for patients with atrial fibrillation
What information is used in a CHA2DS2-VASc score?
C - congestive heart failure
H - hypertension
A2 - age >75
D - diabetes
S2 - stroke/TIA in past
V - vascular disease (past MI, PAD)
A - age > 65
S - female sex
What does a CHA2DS2-VASc score mean and how are they managed?
- 0 in males, 1 in females = low risk (no treatment needed)
- 1 in males, 2 in females = moderate risk (consider oral anticoagulation - apixaban)
- > 2 in males, >3 in females = high risk (offer oral anticoagulation - apixaban)
What is the Well’s score used for?
Estimating the risk of DVT (used in outpatient or emergency department settings)
What information is used in a Well’s score
- Active cancer
- Bedridden recently >3 days, or major surgery within 12 weeks
- Calf sweeling >3cm compared to the other
- Entire leg swollen
- Collateral (non-varicose) superficial veins present)
- Localised tenderness
- Pitting oedema of symptomatic leg
- Paralysis, paresis, or immobilization of leg
- Previously documented DVT
- Alternative diagnosis to DVT more or as likely (-2 points)
What does a Well’s score mean?
0 = low risk (“unlikely DVT”)
- probability = 5%
1-2 = moderate risk
- probability = 20%
3 or more = high risk (“likely DVT”)
- probability = 20-50%
How is each Well’s score category managed?
Low risk
- high or moderate sensitivity d-dimer
- if positive, procced to US
- positive US = anticoagulation
Moderate risk
- high sensitivity d-dimer
- if positive, proceed to US
- positive US = anticoagulation
High risk
- all patient receive US
- any positive US = anticoagulation
- d-dimer used to asses risk
What is a FRAX score used for?
Estimating the risk of having an osteoporotic fracture in the next 10 years
What information is used in the FRAX score?
Age
Sex
Weight
Height
Previous fracture
Parent fractured hip
Current smoking
Use of glucocorticoids
Rheumatoid arthritis
Secondary osteoporosis (eg. diabetes, premature menopause, malabsorption)
Alcohol (3 or more units/day)
Bone mineral density (DXA scan of femoral neck)
What does each FRAX score mean and how are they managed?
*category depends on % and age
- Low risk (green zone): give lifestyle advice and reassess in 5 years
- Intermediate risk (yellow zone): measure BMD and recalculate risk then treat if above intervention threshold
- High risk (red zone): offer treatment (calcium/vitamin D supplements, bisphosphonates)
- Very high risk (dark red zone): consider referral to specialist for treatment (anabolic/bone-forming treatments)
What is the diabetes risk score used for?
Estimating a persons risk of having previously undiagnosed type 2 diabetes
What information is used in a diabetes risk score?
Sex
Prescribed antihypertensives
Prescribed steroids
Age
BMI
Waist measurement
Ethnicity
Family history
Smoking history
How is each diabetes risk score managed?
Low risk =
- encouragement and reassurance
- lifestyle advice
Moderate risk =
- explain risk factors
- over brief intervention for lifestyle changes
- discuss weight loss programmes
High risk =
- explain risk factors
- offer referral to intensive lifestyle-change programme
